4> 


TUFTS   UNIVERSITY    LIBRARIES 


3  9090  013  413  840 


Webster  Family  Library  of  Veterinary  Medicine 

^^^o  ^\io6iuoio  Road  ^^^ 


^iotri  Grafton,  HyiA  01536 


Veteeinaey  Medicine  Sekies 
No.  1 


SPRINGTIME  SURGERY 


Edited  by 
D.  M.  Campbell,  D.V.S. 

Editor,  American  Journal  of  Veterinary  Medicine 

Second  Edition 
Revised  and  Enlarged 


Chicago 

American  Journal  of  Veterinary  Medicine 

1914 


Copyright,  1912 
D.  M.  Campbell 


Veterinary  Medicine  Series 
No.  1 


PREFACE  TO  THIRD  EDITION 


Advantage  has  been  taken  of  the  exhaustion 
of  the  last  edition  to  correct  a  few  typographical 
errors  and,  at  the  suggestion  of  the  authors,  to 
make  slight  changes  in  some  of  the  articles. 

The  remarkable  sale  of  this  work  has  made 
necessary  the  third  edition,  within  a  year  from 
the  date  of  its  first  publication.  There  are  many 
evidences  that  it  has  proven  helpful  to  a  large 
number  of  veterinarians  and  that  this  edition 
will  meet  with  the  cordial  response  given  its 
predecessors. 

The  Editor. 

Chicago,  March  1913. 


Veterinary  Medicine  Series 
No.  1 

PREFACE  TO  SECOND  EDITION 


The  fact  that  a  second  edition,  of  a  veterinary 
publication,  should  be  required,  within  thirty 
days  from  the  time  the  first  edition  was  received 
from  the  bindery — thus  establishing  a  new  record 
among  veterinary  publications — is  proof  positive 
of  its  usefulness  and  its  welcome.  Springtime 
Surgery  has  had  this  remarkable  sale.  A  higher 
commendation  is  scarcely  possible,  a  further  one 
unnecessary. 

This  work  is  unique,  an  innovation  in  veterinary 
literature,  and  has  appealed  strongly  to  practis- 
ing veterinarians.  The  thanks  of  the  editor,  and 
all  credit  for  the  usefulness  of  Springtime  Sur- 
gery, are  due  to  the  contributors  who  have  given 
of  their  time  and  talents  for  the  enlightenment  of 
the  Profession. 

Three  articles  have  been  included  in  this  that 
are  not  contained  in  the  former  edition,  two  in 
the  former  have  been  omitted  from  this  edition. 
A  number  of  those  in  the  first  edition  have  been 
thoroughly  revised  for  this  one  by  the  authors. 

The  Editor. 
Chicago,  April,  1912. 


SUCCESS 

Pluck  will  win — its  average  is  sure, 

He  wins  the  fight  who  can  the  most  endure. 

Who  faces  issues,  he  who  never  shirks, 

Who  waits  and  watches  and  who  always  works. 

{Author  unknotun). 


PREFACE  TO  FIRST  EDITION 


There  is  an  obvious  advantage  in  having 
grouped,  in  one  small  volume,  really  meritorious 
discussions  of  the  cases  most  common  at  any 
season.  The  articles  in  this  book,  which  are  re- 
printed from  the  American  Journal  of  Veteri- 
nary Medicine,  constitute,  we  believe,  the  most 
instructive  yet  brief  description,  and  the  most 
helpful  case-reports  to  be  gleaned  from  the  liter- 
ature on  the  surgical  and  obstetric  problems  com- 
mon during  the  foaling  and  castrating  season. 
The  discussions  of  ''Springtime  Surgery,"  while 
in  no  sense  exhaustive,  yet  constitute,  for  the 
practising  veterinarian,  a  valuable  supplement  to 
the  standard  textbooks  of  veterinary  surgery 
and  obstetrics. 

The  superior  merit  of  these  articles  amply 
justifies  their  reproduction  in  a  form  more  per- 
manent than  is  offered  by  magazine  publication. 
The  frequent  requests  from  subscribers  for 
copies  of  the  issues  of  "Veterinary  Medicine" 
containing  various  of  these  articles  convinces  us, 
that  their  presentation  in  book  form  will  be  wel- 
comed by  a  large  number  of  veterinarians  and 
that  this  volume  will  be  of  much  usefulness  in 
this  field. 

The  Editor. 

Chicago,  March,  1912. 


TABLE  OF  CONTENTS 


Castration  of  Cryptorchids   9 

Practical  Methods  of  Cryptorchidectomy 39 

Cryptorchidectomy  in  Horses 75 

An  Interesting  Monorchid  83 

A  Castrator*s  Error 87 

Hemorrhage  After  Castration 91 

Castration  of  Pigs  Having  Scrotal  Hernia ...  93 

Operation  on  a  Hermaphrodite 97 

Spaying  Heifers  on  Western  Ranches 101 

Oophorectomy  in  Cats Ill 

Prolapsus  Uteri:  It3  Successful  Treatment.  .113 

Unusual  Case  of  Obstetrics 116 

Proper  Replacement  of  the  Everted  Uterus.  .117 

Pervious  Urachus 120 

Care  of  Navels  in  Newborn 123 

Superfetation  with  Report  of  a  Case 133 

Atresia  Ani 137 

Treatment  of  Contracted  Tendons  in  Foals. .  .141 

Minor  Means  of  Restraint 145 

The  Treatment  of  the  Injured  Hand 153 


Castration  of  Cryptorchids  * 

By  W.  L.  WILLIAMS,  V.    S.,  Professor  of  Surgery   and 

Obstetrics  in  tlie  New  York  State  Veterinary  College, 

Cornell  University,  Ithaca,  New  York,  author  of 

"Veterinary  Obstetrics,"  "Surgical  and 

Obstetric   Operations,"    etc. 

It  is  generally  considered  advisable  to  castrate 
all  male  domestic  animals  which  are  to  be  regu- 
larly used  for  work  or  as  human  food.  However 
true  this  may  be  of  normal  males,  it  is  empha- 
sized in  most  cases  of  cryptorchids  or  hidden 
testes. 

It  is  especially  desirable  that  the  cryptorchid, 
or  the  monorchid,  be  castrated,  in  order  that  he 
may  not  be  used  for  breeding  purposes,  because 
he  may  largely  transmit  the  defect  to  his  off- 
spring. In  addition  to  this,  the  abdominal  testicle 
usually  induces  a  perverted  sexual  desire,  closely 
analogous  to  the  nymphomania  of  the  female. 


♦Reprinted  from  the  Missouri  Valley  Veterinary  Bulletin,  April,  1910. 


10  SPRINGTIME  SURGERY 

Etiology. — ^The  causes  of  cryptorchidy  are 
various,  and  are  not  wholly  understood.  We 
meet  with  three  groups  of  causes  or  conditions 
which  are  of  interest: 

1.  Arrested  development,  or  descent  of  the 
organ. 

2.  Aberration  of  the  development  of  the  organ 
— ^teratoma. 

3.  Pathologic  conditions  of  the  testes. 

In  the  first  case,  the  testicle  forms  normally, 
and  drops  from  its  embryonic  location  into  the 
peritoneal  cavity,  but  fails  to  descend  into  the 
scrotum.  It  then  retains  its  fetal  character,  is 
small,  soft,  flaccid  and  histologically  shows  the 
fetal  spermatoblasts,  but  no  spermatozoa.  The 
gland  is  therefore  without  procreative  function, 
but  induces  often  a  sexual  mania.  Its  position 
varies,  being  located  at  any  point  on  a  line  pass- 
ing from  the  embryonic  seat,  near  the  posterior 
end  of  the  kidney,  to  and  into  the  internal  in- 
guinal ring. 

The  second  class,  the  teratoma,  comprises  a 
widely  varying  group  of  dermoid  cysts,  of  al- 
most any  dimensions  and  containing  epidermal 


CASTRATION  OF  CRYPTORCHIDS  11 

debris  and  structures,  such  as  hair,  dental  tissues, 
etc.  They  are  highly  interesting  because  they 
suggest  that  the  sexual  glands  are  really  of  epi- 
blastic  origin,  as  contended  by  some  embryolo- 
gists,  instead  of  mesoblastic,  as  asserted  by  most 
authorities. 

The  third  group  comprises  extremely  variable 
pathologic  changes,  such  as  cystic,  calcareous  or 
other  forms  of  degeneration,  malignant  new- 
growths,  etc. 

These  three  groups  are  known  to  be  of  very 
unequal  size,  though  definite  data  as  to  the  pro- 
portions of  each  are  wanting.  Ninety-one  cases 
have  been  operated  upon  in  our  clinic,  of  which 
ninety  belonged  to  the  first  group,  none  to  the 
second,  and  one  to  the  third.  In  private  practice 
we  have  met  with  one  additional  case  of  patho- 
logic testicle,  but  no  teratoma. 

The  teratoma  are  considered  so  unusual  that 
they  are  largely  recorded,  and  probably  an  ex- 
aggerated idea  of  their  prevalence  is  acquired. 
It  is  highly  important  that  these  three  classes  be 
kept  in  mind,  since  they  have  an  essential  bear- 
ing upon  the  surgical  procedure  in  castration. 


12  SPRINGTIME  SURGERY 

Other  less  essential  elements  entering  into  the 
surgical  problem  of  cryptorchidy  are  whether  the 
testicle  is  abdominal  or  inguinal  in  location,  and 
to  what  species  the  animal  belongs. 

Cryptorchid  castration,  like  many  surgical  pro- 
cedures, was  at  first  chiefly  empiric  in  character, 
and  in  fact  is  still  largely  practiced  as  an  empiric 
operation,  the  operation  being  largely  taught  and 
learned  in  a  manner  devoid  of  scientific  knowl- 
edge. 

Preparation. — The  preparation  of  an  animal 
for  the  cryptorchid  operation  does  not  differ  ma- 
terially from  the  general  rule  for  other  abdominal 
operations.  We  desire  that  the  patient  shall  be 
in  prime  physical  condition,  having  had  abundant 
exercise  or  work  to  place  him  in  good,  vigorous 
health.  Before  the  operation,  the  alimentary  tract 
should  be  emptied  either  by  restricted  diet  or  by 
hypodermic  catharsis.  Fullness  of  the  alimen- 
tary tract  should  be  obviated  for  general  surgical 
reasons  and  for  the  special  purpose  of  facilitating 
the  operation,  by  affording  greater  intra-abdomi- 
nal room  and  preventing  prolapse  of  abdominal 
viscera  through  the  wound. 


CASTRATION  OF  CRYPTORCHIDS  13 

Control. — The  securing  of  the  patient,  in  case 
of  the  horse,  needs  be  either  in  dorsal  recum- 
bency, or  in  the  lateral  position,  with  that  side 
upon  which  the  hidden  testicle  is  located,  upper- 
most. There  is  but  one  essential  detail  in  secur- 
ing the  horse :  The  thigh  on  the  side  of  the  hid- 
den testicle  must  be  fully  abducted.  This  may  be 
effectively  accomplished  by  many  methods  of  cast- 
ing, and  may  be  perfectly  attained  upon  some 
types  of  operating  table. 

If  the  thigh  is  not  completely  abducted,  the 
operator  may  find  his  hand  so  compressed  that  it 
is  soon  fatigued  and  disabled,  and  the  operator 
confused  and  lost.  It  is  a  great  error  to  attempt 
the  operation  except  this  abduction  is  complete 
and  secure.  Should  the  apparatus  slip  during  the 
operation,  and  the  operator's  hand  become  com- 
pressed, it  is  liable  to  greatly  confuse  even  an  ex- 
perienced surgeon. 

The  question  of  general  anesthesia  is  one  upon 
which  operators  may  justly  differ.  For  the  be- 
ginner, it  is  the  best  way.  The  beginner  may, 
under  proper  aseptic  precautions,  manipulate  an 
anesthetized  cryptorchid  for  half  an  hour  or  an 


14  SPRINGTIME  SURGERY 

hour,  without  serious  harm  to  the  patient,  and 
without  seriously  transgressing  the  general  senti- 
ment of  humanity  for  animals,  which  is  develop- 
ing so  rapidly  amongst  our  people.  Anesthesia  is 
also  highly  important  for  the  experienced  opera- 
tor. The  inguinal  region  needs  to  be  kept  as 
freely  open  and  the  tissues  as  passive  as  possible, 
this  can  be  attained  only  by  general  anesthesia. 

When  the  beginner  is  working  upon  an  anes- 
thetized patient,  he  is  relieved  from  the  dis- 
turbances of  change  in  position  and  the  shifting 
in  the  relations  of  parts.  The  abdominal  viscera 
are  not  forcibly  pushed  against  his  hand  or 
through  the  opening.  It  is  of  great  importance 
also  that  the  beginner  should  be  relieved,  through 
the  general  anesthesia  of  his  patient,  from  the 
confusing  and  enervating  mental  anxiety  caused 
by  the  pain  he  is  otherwise  inflicting  upon  the  pa- 
tient, as  expressed  by  violent  struggling,  sweat- 
ing, groaning,  etc. 

Again,  general  anesthesia  is  always  best,  even 
for  the  experienced  operator  in  all  cases  of  com- 
plications, and  the  surgeon  rarely  knows  that  a 
case  is  complicated  until  deeply  in  the  operation, 


CASTRATION  OF  CRYPTORCHIDS  15 

where  he  cannot  retreat  or  readily  modify  his 
plans.  We  believe  in  general  anesthesia  in  all 
cases. 

Diagnosis.— ; Some  advise  rectal  exploration 
procedure  has  certain  value.     In  those  cases  of 

prior  to  securing  the  patient  for  operation.  The 
monorchidy  where  the  scrotal  testicle  has  been 
removed  (a  very  unfortunate  and  inadvisable 
procedure) ,  the  operator  may  determine  definitely 
upon  which  side  the  hidden  testicle  is  located.  It 
may  further  give  him  important  information  as 
to  whether  the  retained  gland  falls  within  our 
first,  second,  or  third  class.  Should  it  belong  to 
the  second  or  third  class,  the  examination  reveals 
to  the  operator  the  nature  of  the  conditions,  fore- 
warns him  of  the  obstacle  to  be  overcome,  and  en- 
ables him  to  plan  his  operation. 

On  the  whole,  rectal  exploration  prior  to  opera- 
tion is  largely  impracticable.  It  is  generally  in- 
convenient to  make  such  examination  until  im- 
mediately prior  to  the  operation,  and  at  that  time, 
it  is  as  a  rule  imprudent  because  of  the  difficulty 
of  cleansing  the  hands  properly  after  they  have 
been  soiled  by  feces. 


16  SPRINGTIME  SURGERY 

Asepsis  and  Disinfection — Another  point 
of  very  great  importance  is  the  question  of  dis- 
infection of  the  operative  area,  and  the  main- 
tenance of  asepsis.  The  problem  is  somewhat 
alike,  whether  the  incision  be  made  in  the  scro- 
tal, inguinal,  prepubian  or  flank  region.  In  the 
horse,  the  incision  is  usually  made  in  the  scrotal 
or  inguinal  region,  while  in  other  animals  it  is 
best  made  in  the  upper  flank.  While  the  skin  of 
the  scrotal  and  inguinal  regions  is  very  thin,  soft, 
and  usually  almost  hairless,  it  is  nevertheless 
thickly  covered  with  sebum,  which  is  very  insolu- 
ble and  difficult  to  remove.  Washing  for  a  few 
minutes  with  any  ordinary  antiseptic,  even  though 
preceded  by  soap  and  warm  water,  is  of  scant, 
if  any  value.  The  problem  of  the  practical  dis- 
infection of  this  region  has  not  been  solved.  The 
profuse  application  of  alcoholic  or  ethereal  solu- 
tions excoriate  the  delicate  skin. 

Careful  investigations  need  be  made  toward 
solving  this  problem.  Possibly  a  good  method 
would  be  to  wash  the  parts  thoroughly,  an  hour 
or  two  prior  to  the  operation,  with  soap  and  hot 
water,  perhaps  mixed  with  kerosene  in  emulsion. 


CASTRATION  OF  CRYPTORCHIDS  17 

or  with  lysol,  bacterol,  or  carbolic  acid.  The 
sheath  being  always  dirty  bacteriologically,  the 
smegma  from  this  should  be  carefully  cleared 
away,  and  the  sheath  and  prepuce  anointed  with 
an  antiseptic  oil,  glycerin  or  vaseline.  The  skin 
having  been  allowed  to  dry  completely,  when  the 
patient  is  secured  for  the  operation,  the  opera- 
tive area  may  be  liberally  covered  with  tincture 
of  iodine,  and  allowed  to  dry  before  making  the 
incision.  After  the  skin  incision  has  been  made, 
additional  security  might  be  attained  by  again 
applying  the  tincture  of  iodine  to  the  margins  of 
the  cutaneous  wound. 

Incision. — Some  operators  make  their  incision 
through  the  skin  and  dartos  in  the  scrotal  region, 
parallel  to  the  median  raphe  and  one  to  two  inches 
laterally  therefrom.  Others  make  their  incision 
directly  over  the  external  inguinal  ring  and  in  the 
same  direction.  By  the  first  method,  the  operator 
inserts  his  hand  through  the  wound  in  the  skin 
and  dartos,  divides  the  loose  areolar  connective 
tissue  and  pushes  aside  the  numerous  vessels,  in 
an  upward  and  outward  direction  until  he  reaches 
the  external  inguinal  ring  immediately  at  that 


18  SPRINGTIME  SURGERY 

point  at  which  the  second  operator  would  make 
his  incision. 

The  incision  over  the  external  ring  is  therefore 
more  direct  and  the  resulting  wound  less  exten- 
sive, in  which  respect  it  is  more  conservative  and 
preferable.  The  scrotal  incision  has  the  impor- 
tant advantage  over  the  inguinal,  in  that  the  in- 
evitable movements  of  the  thigh  after  the  opera- 
tion disturb  the  cutaneous  wound  over  the  inguinal 
ring,  but  do  not  seriously  involve  the  scrotal 
wound.    We  prefer  the  scrotal  incision. 

Inguinal  Cryptorchidism.  —  Having  reached 
the  loose  areolar  tissue  in  the  external  abdomi- 
nal ring,  whether  indirectly  through  a  scrotal  in- 
cision or  directly  through  an  inguinal  wound,  the 
operator,  with  his  fingers  in  the  form  of  a  cone, 
and  by  means  of  a  rotary  motion,  pushes  the 
areolar  tissues  aside  and  cautiously  advances  his 
hand  upwards,  outwards  and  slightly  forwards 
toward  the  internal  inguinal  ring,  or  the  position 
which  it  should  occupy.  Care  should  be  taken  to 
note  here  the  presence  or  absence  of  a  dis- 
tinguishable gubernaculum  testis,  of  the  epididy- 
mis or  of  the  testicle  itself. 


CASTRATION  OF  CRYPTORCHIDS  19 

If  a  recognizable  gubernaculum  is  present,  it 
may  be  an  important  guide  to  the  internal  ring, 
and  hence  an  aid  of  value  to  the  operator,  especi- 
ally to  the  beginner;  or  the  operator,  by  grasping 
this  and  drawing  upon  it,  may  bring  the  testicle 
out  through  the  ring  and  grasp  it.  Usually  the 
presence  or  absence  of  this  structure  in  a  recog- 
nizable form  may  be  suspected  by  the  presence 
or  absence  of  a  distinct  dimple  or  depression  at 
the  fundus  of  the  scrotum. 

When  the  epididymis  has  descended  into  the 
scrotum,  it  is  recognized  as  a  somewhat  firm  cord 
about  the  size  of  a  man's  finger,  and  is  well  nigh 
indistinguishable  from  the  stump  of  the  sper- 
matic cord  following  castration.  It  is  more  free 
from  adhesions  to  surrounding  tissues,  and  its 
obtuse  extremity  is  connected  with  the  skin  and 
dartos  only  by  the  indistinct  gubernaculum.  Cut- 
ting through  the  peritoneal  sheath  of  the  cord, 
the  operator  exposes  the  vas  deferens  and  tail  of 
the  epididymis  firmly  attached,  naturally,  not  by 
adhesions,  at  the  distal  end  of  the  tubular  cord. 
By  exerting  traction  upon  the  tail  of  the  epididy- 
mis, the  head  of  that  organ  may  be  brought  into 


20  SPRINGTIME  SURGERY 

view,  the  entire  epididymis  being  abnormally 
elongated  and  attenuated.  The  testicle  itself  re- 
mains firmly  lodged  above  the  internal  ring,  or 
incarcerated  in  it,  and,  however  much  traction 
may  be  exerted  on  the  epididymis,  the  gland 
usually  remains  immovably  fixed. 

The  first  case  of  this  kind  with  which  we  met 
led  us  into  error,  and  we  removed  the  epididymis 
and  a  portion  of  the  vas  deferens,  while  we  left 
the  testicle  in  the  abdomen.  Later  in  our  clinic 
we  operated  upon  a  case,  the  history  of  which 
could  not  be  traced,  but  which  had  evidently  been 
operated  upon  by  some  one  who  had  fallen  into 
the  same  error,  removing  the  epididymis  and 
leaving  the  testicle.  The  condition  offers  some 
difficulty  to  overcome.  The  most  direct  method  is 
to  freely  incise  the  peritoneal  sheath  down  to  the 
internal  ring  and  either  dilate  this  by  forcing  the 
finger  through  the  ring  along  side  of  the  vas  de- 
ferens and  epididymis,  or  by  cautiously  incising 
the  ring  with  a  scalpel  or  bistoury.  The  testicle 
may  then  be  withdrawn  and  removed. 

If  the  testicle  itself  is  encountered  in  this  re- 
gion (inguinal  cryptorchidism)  the  gland  is  to  be 


CASTRATION  OF  CRYPTORCHIDS  21 

seized  and  forcibly  brought  out  through  the 
wound.  Having  passed  through  the  internal  ring, 
the  gland  is  covered  by  the  cremasteric  fascia  or 
tendon  and  by  the  parietal  peritoneum,  which  are 
to  be  incised  as  soon  as  brought  to  view,  and  the 
testicle  laid  bare.  It  is  to  be  noted  that  in  all 
cases  of  abdominal  cryptorchidism,  including 
those  we  have  mentioned  where  the  epididymis 
has  descended  into  the  scrotum,  the  testicle,  when 
brought  out,  is  naked;  while  in  inguinal  cryptor- 
chidism, the  testicle  is  inevitably  brought  out 
covered  by  the  cremasteric  structures  and  the 
parietal  peritoneum. 

Locating  the  Internal  Inguinal  Ring. — 
Encountering  neither  gubernaculum,  epididymis 
or  testicle  in  the  inguinal  region,  the  operator 
should  search  for  and  locate  the  internal  abdom- 
inal ring,  whether  he  designs  to  penetrate  it  or 
not,  as  it  constitutes  the  immediate,  logical  guide 
to  the  location  of  the  testicle. 

This  ring  may  usually  be  recognized  in  the 
cryptorchid  horse,  as  an  elliptical  slit,  appearing 
to  the  touch  as  about  three-fourths  to  one  and 
one-fourth  inches   long  by  one-half  inch  wide, 


22  SPRINGTIME  SURGERY 

directed  obliquely  forward  and  outward  in  its 
greater  diameter.  It  is  covered  by  a  thin  layer 
of  peritoneum,  while  its  margins,  the  borders  of 
the  great  and  small  oblique  muscles,  are  distin- 
guished by  their  greater  thickness  and  firmness. 
This  ring  is  located  two  to  four  inches  upward, 
outward  and  slightly  forward  from  the  external 
abdominal  ring.  It  is  just  opposite  and  very  near 
to  the  crural  ring,  and,  by  palpating  outward 
against  the  thigh,  the  operator  easily  recognizes 
the  pulsating  femoral  artery  as  it  emerges  from 
the  crural  ring. 

In  some  cases  the  internal  ring  is  unrecog- 
nizable by  palpation,  but  the  determination  of  its 
approximate  location  is  nevertheless  essential  to 
scientific  cryptorchid  castration.  The  recog- 
nition of  the  ring  is  especially  difficult  in  animals 
previously  operated  upon  unsuccessfully,  and  fol- 
lowed by  the  formation  of  a  large  amount  of 
dense,  cicatricial  tissue.  When  the  ring  has  been 
recognized,  if  the  operator  will  approximate  his 
thumb,  index,  and  second  fingers  to  constitute  an 
incomplete  circle  of  one  to  two  inches  in  diameter 
and  press  the  ends  of  the  digits  against  the  abdom- 


CASTRATION  OF  CRYPTORCHIDS  23 

inal  muscles  about  the  margins  of  the  ring,  the 
peritoneal  curtain  closing  the  ring,  the  processus 
vaginalis,  tends  to  push  outward  in  the  form  of 
an  obtuse  cone,  while  enclosed  within  it  are  the 
gubernaculum  and  usually  the  tail  of  the  epididy- 
mis and  the  base  of  the  vas  deferens.  The  guber- 
naculum, in  its  intra-abdominal  position,  is  recog- 
nized, as  a  somewhat  distinct,  firm,  straight  cord, 
about  one-eighth  of  an  inch  in  diameter,  some- 
what movable  within  the  peritoneum.  The  two 
latter  are  recognizable  as  hard  dense,  coiled  cords 
or  filaments,  which  are  readily  grasped  beween 
the  thumb  and  fingers,  and  clearly  recognized  by 
palpation. 

Securing  the  Testicle.—  These  facts  we  have 
found  of  the  greatest  importance  in  the  clinical 
teaching  of  the  operation.  It  is  the  keynote  in 
our  method  of  instruction.  We  advance  the 
operation  to  this  point,  seize  the  processus  vagin- 
alis enclosing  the  gubernaculum,  the  vas  deferens 
or  the  tail  of  the  epididymis  between  the  thumb 
and  fingers,  introduce  a  long  pair  of  forceps,  and 
seize  the  gubernaculum,  epididymis  or  vas  defer- 
ens, still  covered  by  the  peritoneum.     We  then 


24  SPRINGTIME  SURGERY 

secure  the  forceps  in  this  position,  with  the  de- 
sired structure  firmly  caught,  and  the  beginner 
introduces  his  hand,  palpates  all  the  parts,  rup- 
tures the  peritoneum,  grasps  the  gubernaculum 
and  then  the  vas  deferens,  followed  by  the  epi- 
didymis, and  completes  the  operation. 

Reaching  and  recognizing  the  internal  ring, 
operators  divide  themselves  into  two  or  more 
groups  in  their  further  procedure. 

We  recommend,  in  those  cases  we  have  just 
mentioned,  in  which  the  operator  can  grasp  the 
vas  deferens  or  epididymis  outside  the  ring  in  the 
processus  vaginalis,  still  covered  by  the  perito- 
neum, that  the  peritoneal  covering  be  ruptured 
by  dragging  upon  it,  the  tail  of  the  epididymis 
grasped  and  drawn  out  and  the  testicle  itself 
brought  out  by  traction  upon  the  epididymis,  thus 
completing  the  operation  without  the  insertion  of 
the  hand  or  even  of  a  finger  into  the  abdominal 
cavity.  In  some  cases,  the  testicle  may  not  be 
drawn  through  the  narrow  ring  by  traction  alone, 
in  which  instances  we  insert  an  index  finger, 
dilate  the  ring,  and,  exerting  traction  on  the  epi- 


CASTRATION  OF  CRYPTORCHIDS  25 

didymis  with  the  other  hand,  guide  the  gland 
through  the  ring  with  the  introduced  finger. 

Should  we  be  unable  to  grasp  the  epididymis 
outside  the  ring,  we  penetrate  the  ring  with  an 
index  finger,  and,  directing  it  backward,  hook  the 
index  finger  over  the  gubernaculum  as  it  leaves 
the  posterior  margin  of  the  ring,  to  immediately 
lose  itself  in  the  tail  of  the  epididymis.  This  is 
grasped,  drawn  through  the  ring,  and  the  opera- 
tion then  proceeds  as  before. 

Should  the  operator  fail  to  locate  the  ring,  he 
needs  at  least  to  determine  its  approximate  loca- 
tion, penetrate  the  muscular  wall  as  near  to  the 
normal  position  of  the  ring  as  he  can  determine 
with  his  index  finger,  and,  palpating  the  surface 
of  the  peritoneum,  locate  and  grasp  the  guberna- 
culum, and  eventually  the  vas  deferens. 

Theoretically,  should  the  operator  fail  to  locate 
the  testicle  by  this  plan,  he  should  next  introduce 
the  entire  hand  into  the  peritoneal  cavity,  again 
search  for  the  gubernaculum,  the  epididymis,  and 
especially  for  the  gland  itself,  and  as  a  final  re- 
sort search  for  the  vas  deferens  about  the  urethra 
and  trace  it  back  to  the  gland. 


26  SPRINGTIME  SURGERY 

Practically,  when  an  operator  must  insert  his 
entire  hand  into  the  abdominal  cavity  in  his  search 
for  the  testicle,  it  is  the  operator,  and  not  the  tes- 
ticle, which  is  lost,  with  often  a  far  too  poor  pros- 
pect of  finding  himself  and  recognizing  the  defi- 
nitely located  and  attached  organ. 

Too  many  operators,  and  especially  beginners, 
search  for,  and  attempt  to  identify  the  testicle, 
without  considering  the  relations  to  the  gland  of 
the  gubernaculum  and  vas  deferens.  Searching 
independently  of  these  for  the  gland  is  like  a 
shore  fisherman  on  a  dark  night,  who  has  securely 
hooked  and  landed  a  fish  in  the  darkness,  and 
starts  groping  about  to  find  it,  instead  of  follow- 
ing his  pole  to  the  line,  and  thence  along  the  line 
to  the  hook,  where  the  fish  is  definitely  fixed  and 
located.  So,  in  castrating  a  cryptorchid,  the  tes- 
ticle need  not  be  "found"  in  the  common  mean- 
ing of  the  word,  because  it  is  not  "lost,**  for  the 
epididymis  and  vas  deferens  are  definitely  and 
closely  moored  at  the  posterior  commissure  of  the 
internal  ring  by  the  gubernaculum  and  at  the 
proximal  end  of  the  epididymis,  securely  fixed,  is 
the  gland  itself. 


CASTRATION  OF  CRYPTORCHIDS  27 

Going  back  to  the  course  of  the  operation,  when 
the  operator  has  reached  the  internal  ring  or  its 
immediate  vicinity,  many  operators  diverge  from 
the  technic  we  have  recommended. 

Instead  of  penetrating  the  ring,  they  push 
somewhat  upward  and  forward  and  penetrate  the 
fascia  of  the  small  oblique  muscle.  By  this  plan, 
the  insertion  of  at  least  one  finirer  in  the  abdom- 
inal cavity  is  necessitated,  which,  by  the  direct 
method  we  have  suggested,  may  be  obviated.  Be- 
yond this,  the  operation  is  identical. 

It  is,  we  believe,  erroneously  contended  by  the 
advocates  of  this  plan  that  prolapse  of  the  abdom- 
inal viscera  is  thereby  obviated.  The  only  cases 
of  visceral  prolapse  from  cryptorchid  castration 
observed  in  our  clinic  have  been  patients  operated 
upon  by  experienced  castrators  who  were  uncom- 
promising devotees  to  this  plan,  and  applied  the 
technic  in  their  operations. 

In  the  ordinary  cryptorchid  castration,  where 
the  testicle  is  small  and  flaccid,  and  where  it  is 
dravni  through  the  ring  by  traction  on  the  vas 
deferens  and  epididymis  or  the  withdrawal  is  sup- 
plemented by  the  very  slight  dilation  of  the  ring 


28  SPRINGTIME  SURGERY 

by  the  insertion  of  one  finger,  the  danger  from 
visceral  prolapse  is  very  remote.  We  have  not 
observed  the  accident  under  these  conditions. 

If  the  entire  hand  is  forced  through  the  ring, 
admittedly  there  is  danger  of  prolapse.  If  the 
entire  hand  is  forced  through  the  fascia  of  the 
small  oblique  above  and  anterior  to  the  internal 
ring  or  elsewhere  in  the  vicinity,  the  inevitable 
rent  will  pass  down,  and  involve,  or  pass  along- 
side the  ring  and  produce  a  tear  essentially  iden- 
tical with  that  caused  by  forcing  the  hand  directly 
through  the  ring. 

Pathologic  Testicles. —  Should  the  testicle  fall 
within  the  second  or  third  class  we  have  men- 
tioned, and  be  greatly  enlarged,  so  that  it  must 
be  removed  entire,  it  matters  little  whether  the 
internal  ring  is  enlarged  to  permit  its  escape  or 
the  same  sized  opening  is  made  in  close  prox- 
imity to  the  ring.  There  results  a  great  rent 
through  which  visceral  prolapse  is  highly  proba- 
ble. Should  the  operator  know  in  advance  that 
he  has  a  testicle  of  extraordinary  size  to  deal 
with,  he  should  abandon  the  inguinal  route  and 
choose  the  upper  flank  as  the  safer  and  better. 


CASTRATION  OF  CRYPTORCHIDS  29 

Indeed,  under  modern  surgical  technic*  the 
flank  operation  is  in  any  case  quite  as  safe  as 
the  inguinal,  whenever  the  operator  inserts  his 
hand  into  the  peritoneal  cavity. 

Should  the  testicle  be  in  a  pathologic  state,  and 
adherent  to  the  intestines  or  other  viscera,  the 
flank  operation  is  advisable  or  even  necessary. 
In  the  one  pathologic  testicle  removed  in  our 
clinics,  the  patient  being  a  pig,  the  testicle  was 
firmly  adherent  to  two  loops  of  small  intestine. 
It  was  necessary  to  draw  these  out  with  the 
gland  and  dissect  them  away. 

In  other  animals  than  the  horse,  we  con- 
stantly prefer  the  flank  operation,  except  we  can 
recognize  the  epididymis  in  the  inguinal  region, 
and  draw  the  gland  out  by  traction. 

Laparotomy. — For  the  flank  operation,  the 
patient  is  secured  in  lateral  recumbency  with 
the  head  end  inclined,  the  flank  shaved  and  dis- 
infected, and  an  incision  is  made  as  for  flank 
spaying,  of  a  size  to  admit  one  finger  or  the  en- 
tire hand,  according  to  the  conditions. 

In  small  pigs  and  dogs  and  cats  we  have  found 
the  small  wound  sufficient.     In  large  boars  we 


80  SPRINGTIME  SURGERY 

have  been  forced  to  make  the  opening  large 
enough  to  admit  the  hand. 

Inserting  the  index  finger,  or  the  entire  hand, 
the  operator  frequently  recognizes  the  gland  at 
once,  lying  just  by  the  incision.  Otherwise  he 
reaches  the  inguinal  ring,  grasps  the  guberna- 
culum,  glides  along  it  to  the  epididymis,  and 
thence  to  the  testicle. 

Double  Cryptorchids.— In  double  cryptor- 
chidisnj  in  small  animals,  both  testes  may  be  re- 
moved through  one  incision,  or,  having  opened 
the  wrong  flank  when  but  one  gland  is  retained, 
he  may  still  complete  his  operation  through  the 
erroneous  incision.  He  merely  needs  pass  his  in- 
dex finger,  or  his  hand,  along  the  floor  of  the 
abdomen,  across  to  the  opposite  inguinal  ring, 
gra^p  the  gland,  draw  it  across  to  the  other  side 
and  out  through  the  incision. 

So,  in  the  cryptorchid  horse,  if  he  is  a  double 
cryptorchid  and  the  operator  has  inserted  his  en- 
tire hand  in  order  to  secure  the  first  testicle,  he 
should  not  make  a  second  wound,  but  reach 
across  beween  the  viscera  and  abdominal  floor, 
seize  the  second  testicle  and  remove  it  through 


CASTRATION  OF  CRYPTORCHIDS  31 

the  first  wound.  Likewise,  in  operating  upon  a 
horse  with  one  abdominal  testicle,  where  the 
scrotal  testicle  has  been  removed,  and  the  opera- 
tor errs  by  cutting  in  upon  the  wrong  side  and 
has  inserted  his  hand  into  the  peritoneal  cavity, 
he  should  not  make  a  second  wound,  but  remove 
the  testicle  through  the  wound  already  made. 

After  Treatment.— After  a  cryptorchid  tes- 
ticle has  been  withdrawn  from  the  abdomen,  the 
method  of  severing  the  cord  is  usually  a  minor 
matter.  In  our  first  class,  which  includes  proba- 
bly ninety-nine  per  cent  of  the  cases,  and  in 
which  the  gland  has  been  arrested  in  its  develop- 
ment, it  is  comparatively  non-vascular  and  does 
not  bleed. 

The  completion  of  the  operation  may  vary.  In 
the  flank  operation,  the  abdominal  wound  is 
naturally  sutured.  If  the  inguinal  operation  has 
been  cleanly  accomplished  with  unimportant  lac- 
eration of  tissues  and  without  danger  of  visceral 
prolapse,  it  may  well  be  sutured.  If  there  is 
danger  of  visceral  prolapse  or  of  serious  infec- 
tion, antiseptic  tampons  should  be  inserted  up  to 
the  internal  ring,  and  held  in  position  by  sutures. 


82  SPRINGTIME  SURGERY 

By  means  of  large  tampons,  an  enormous  rent 
in  the  abdominal  floor  may  be  successfully  closed, 
and  prolapse  obviated.  In  large  rents,  the  safest 
way  to  tamponade  is  to  take  a  broad  and  ample 
piece  of  cheesecloth,  and  spread  it  with  its  center 
over  the  wound.  Then  take  masses  of  convenient 
size  of  gauze,  cheesecloth  or  cotton,  boiled,  im- 
mersed in  a  disinfectant  and  pressed  dry,  and 
push  them  in  to  the  internal  ring,  inside  the  sheet 
of  cheesecloth.  No  matter  should  it  extend  a  few 
inches  into  the  abdomen,  it  cannot  escape.  When 
the  wound  is  well  filled,  the  tampon  is  secured  in 
place  by  scrotal  sutures. 

After  twenty-four  to  forty-eight  hours,  the 
sutures  are  to  be  removed,  the  packing  inside  the 
sheet  of  cheesecloth  cautiously  withdrawn,  fol- 
lowed by  the  sheet  of  cheesecloth  itself.  Blood 
clots  are  then  to  be  mopped  out  with  antiseptic 
gauze,  and,  if  deemed  advisable,  a  new  smaller 
tampon  inserted  for  another  day. 

According  to  the  degree  of  infection,  the  wound 
may  be  let  alone  or  mopped  out  daily  with  swabs 
of  antiseptic  gauze,  preferably  saturated  with 
tincture  of  iodine.     The  inguinal  wound  should 


CASTRATION  OF  CRYPTORCHIDS  33 

not  be  irrigated,  lest  the  antiseptic  be  forced  into 
the  peritoneal  cavity. 

Should  fever  arise,  and  not  be  promptly  re- 
lieved by  local  handling  of  the  wound,  we  recom- 
mend large  doses  of  quinine  or  potassium  iodide, 
usually  preferring  the  former.  To  a  medium 
sized  horse  we  give  one  to  three  ounces  of  quinine 
daily  until  the  fever  yields  or  toxic  effects,  such 
as  trembling  or  diarrhea  appear,  when  we  change 
to  potassium  iodide. 

Mortality.— This  is  not  well  known  in  crypt- 
orchid  castration.  In  the  ninety-one  cases  in 
our  clinic  there  were  included  twenty-eight  pigs, 
one  dog  and  one  cat,  among  which  there  were  no 
losses. 

Of  the  sixty-one  horses,  fifty-six  or  ninety-two 
per  cent  recovered,  and  five  animals  or  eight  per 
cent  died.  These  losses  are  abnormally  high. 
Four  of  the  five  cases  succumbed  to  infection. 

In  the  earlier  years  of  our  clinic,  the  opera- 
tions were  essentially  all  by  students.  In  many 
cases,  six  to  ten  different  students  each  inserted 
his  hand  into  the  inguinal  wound  and  palpated 
the  parts.    Three  of  the  fatal  infections  resulted 


34  SPRINGTIME  SURGERY 

w 

from  this  practice.  This  plan  was  then  aban- 
doned, since  which  but  one  fatality  has  occurred 
from  infection,  following  the  operation  by  a  mem- 
ber of  the  staff. 

Hospital  Infection.— In  our  clinic  we  have 
had  another  obstacle  to  meet.  The  late  Professor 
Williams  of  Edinburg  v/rote  more  than  a  quarter 
of  a  century  ago  advising  against  the  castration 
of  horses  when  the  wind  was  from  the  east,  and 
to  avoid  operating  in  any  kind  of  weather  in  the 
neighborhood  of  a  veterinary  college. 

Whatever  may  be  effect  of  an  east  wind  in 
England,  the  dangers  of  operating  in  a  veteri- 
nary college  are  not  to  be  ignored.  Prior  to  the 
days  of  antiseptic  and  aseptic  surgery,  surgical 
operations  on  man  in  hospitals  were  followed  by 
an  appalling  mortality,  but  the  mortality  from 
wound  infections  in  hospitals  for  man  have  been 
very  largely  overcome. 

Veterinary  surgery  offers  a  different  problem, 
especially  in  the  horse,  and  the  details  of  efficient 
asepsis  and  antisepsis  in  veterinary  hospitals  is 
not  yet  satisfactory.  A  prime  difficulty  in  our 
work  is  cheapness  in  the  construction  and  equip- 


CASTRATION  OP  CRYPTORCHIDS  35 

ment  of  our  veterinary  hospitals,  with  limited 
opportunity  for  efficient  disinfection. 

From  the  beginning  of  our  clinic  in  1896  up  to 
a  recent  date,  we  have  noted  an  increased  ten- 
dency toward  serious  infections,  from  the  open- 
ing of  the  clinic  in  the  autumn  to  its  close  in  June. 
The  hospital  and  operating  room  were  then  va- 
cant and  open  for  the  summer  months.  In  other 
words,  the  presence  in  the  hospital  and  in  the 
operating  room  of  cases  of  fistulous  withers,  poll- 
evil  and  other  chronic,  profusely  suppurating 
maladies  so  befouled  the  establishment  that  viru- 
lent infection  abounded.  Our  crjrptorchid  cas- 
trations came  almost  wholly  toward  the  close  of 
our  school  year,  when  infection  of  our  hospital 
had  apparently  reached  its  highest  virulence. 
This  we  have  fought  so  energetically  that  we  now 
believe  we  can  perform  most  operations  in  our 
hospital  with  greater  safety  than  outside,  and  be- 
lieve we  can  castrate  as  safely  as  anywhere. 
Neither  do  we  observe  increased  infection  as  the 
year  advances.  In  fact,  we  last  year  extended  our 
clinic  to  cover  the  entire  year,  and  are  still  able 
to  keep  wound  infection  under  satsif actory  control. 


36  SPRINGTIME  SURGERY 

Sources  of  Infection.— Aside  from  the  disin- 
fection of  the  instrument  and  of  the  hands,  arms 
and  clothing  of  the  operator,  there  are  other  neg- 
lected sources  of  infection  which  the  veterina- 
rian should  recognize. 

Our  casting  apparatus  constitutes  a  highly 
dangerous  bearer  of  virulent  infections,  and  the 
body  surface  of  the  animal,  with  its  massive  coat 
of  hair,  which  it  is  perhaps  shedding,  affords 
ample  opportunity  for  the  entrance  of  infection 
into  the  wounds.  We  should  devise  better  means 
for  obviating  these. 

Aside  from  infection,  the  mortality  from  crypt- 
orchid  castration  is  well  nigh  negligible.  Of 
course,  casting  accidents  may  occur,  and  some 
losses  have  taken  place  from  intestinal  prolapse. 
The  latter,  can  and  should,  always  be  obviated. 

Complications.— Among  our  five  deaths,  one 
was  due  to  an  accident  based  upon  an  error.  We 
opened  the  patient  on  the  wrong  side,  recognized 
the  vas  deferens  of  the  testicle  which  had  been 
removed,  but,  before  we  were  aware,  had  made  a 
rent  in  its  peritoneal  fold.  We  reached  across 
to  the  opposite  side,  grasped  the  testicle  and  re- 


CASTRATION  OF  CRYPTORCHIDS  37 

moved  it  through  the  wound.  A  loop  of  the  small 
intestine  dropped  through  the  peritoneal  rent  be- 
hind the  vas  deferens  of  the  testicle  which  had 
been  removed  at  a  prior  date,  the  intestine  be- 
came strangulated  and  the  patient  succumbed. 
Had  such  a  result  been  anticipated  or  thought  of 
as  a  possibility  all  danger  could  have  been  obvi- 
ated, after  the  rent  had  been  made,  by  rupturing 
the  vas  deferens,  thus  leaving  no  place  for  the 
incarceration  of  the  viscera. 

So  with  other  complications  which  may  arise. 
The  operator  should  preserve  his  equanimity, 
and,  in  cases  of  error  or  unexpected  complica- 
tions, promptly  and  coolly  meet  the  conditions. 
To  this  end,  the  operator  needs  be  fully  prepared 
for  emergencies,  have  the  surroundings  in  all  es- 
sentials suitable,  have  abundant  help  at  hand, 
and,  beyond  all  else,  needs  be  in  good  physical 
condition,  free  from  fatigue  of  body  or  mind. 

In  the  one  fatal  error  we  have  recorded,  the 
difficulty  was  largely  referable  to  the  fact  that 
the  writer  was  ill,  and  should,  by  all  rules  of  pro- 
fessional action,  have  been  in  bed  instead  of  at 
the  operating  table.    Good  surgical  work  requires 


38  SPRINGTIME  SURGERY 

vigor  of  both  mind  and  body,  and  we  are  forced 
to  see  this  if  we  undertake  an  operation  when 
we  are  unfit,  and  then  meet  with  complications. 


Practical  Methods  of 
Cryptorchidectomy 

By  Charles  Frazier,  B.  Sc,  M.  D.  V.,  Professor  of 

Pathology  and  Bacteriology  and  Dean  of  the 

McKillip  Veterinary  College,  Chicago 

It  is  my  purpose  in  this  article  to  outline  a 
technic  which  has  given  uniform  success  in  my 
hands,  one  that  is  based  on  a  thorough  study  of 
the  anatomical  and  surgical  conditions  met,  and 
one  which  I  am  sure  any  one  can  follow  who  has 
any  skill  whatsoever.  I  want  at  this  point  to  em- 
phasize the  fact  that  the  operation,  as  practically 
carried  out,  is  a  simple  one. 

Preparation  of  the  Patient.-  This  can  be 
summarized  in  one  statement.  Have  the  patient's 
bowels  moderately  full  of  ingesta  and  absolutely 
free  from  the  irritability  produced  by  cathartics, 
change   of  food   and   emptiness.     Do   not   give 


♦Reprinted    from    the    American    Journal    of    Veterinary    Medicine, 
May,  1911. 


40  SPRINGTIME  SURGERY 

cathartics  of  any  kind;  do  not  starve  the  patient 
and  do  not  upset  the  intestinal  canal  by  a  radical 
change  of  food. 

A  bowel  that  is  moderately  distended  with  in- 
gesta,  free  from  all  forms  of  irritation,  in  nor- 
mal and  perfect  physical  and  physiological  con- 
dition, is  the  one  that  is  not  going  to  be  upset  by 
any  amount  of  clea7i  manipulation  in  the  abdo- 
men and  surely  is  not  the  one  to  prolapse  most 
frequently.  Peritoneal  irritability  explains  in  a 
large  degree  prolapses  of  the  omentum.  The 
omentum  has  been  aptly  called  the  "policeman  of 
the  belly,"  searching  out,  as  it  does,  localized 
peritoneal  disturbances,  and  through  some  power 
of  its  own  going  to  such  areas  and  attempting  to 
cover  them  over  by  adhesions,  where  there  is  in- 
jury to  or  loss  of  the  peritoneal  tissue.  Thus  it  is 
apt  to  wander  down  the  inguinal  canal  at  inop- 
portune times. 

Rectal  Examination. —  Prior  to  the  operation 
this  is  not  to  be  thought  of  a^  a  routine  practice. 
In  animals  that  have  had  one  testicle  removed  and 
a  diagnosis  as  to  the  side  is  wanted,  there  is  a 
better  way  of  proceeding  than  by  rectal  examina- 


PRACTICAL   CRYPTORCHID   CASTRATION      41 

tion,  and  further,  in  such  cases,  a  rectal  exami- 
nation by  the  best  operators  gives  no  positive  re- 
sults and  frequently  leads  to  harmful  procedures. 
The  question  of  the  side  upon  which  to  operate  is 
not,  except  very  rarely,  a  difficult  one  to  decide. 
The  answer  is  obvious  if  the  animal  has  never 
been  operated  upon  or  if  one  testicle  has  been 
removed  and  there  is  but  one  scar  and  that 
clearly  upon  one  side  of  the  scrotum.  A  diagno- 
sis is  to  be  made,  not  at  all  upon  the  history  the 
owner  gives,  but  upon  one's  own  findings.  This 
examination  is  to  be  made  after  the  animal  is 
cast,  and  consequently  will  be  considered  later. 

Disinfection. — Antiseptic  applications  to  the 
scrotum,  prepuce  and  thighs,  some  hours  preced- 
ing the  operation,  have  no  place  in  the  technic. 
Theoretically  they  may  be  defended,  but  practi- 
cally they  cannot. 

The  total  pre-operative  treatment  therefore 
consists  of  placing  the  patient  upon  a  moderate 
diet  for  twenty-four  to  forty-eight  hours  preced- 
ing the  operation.  Nothing  else  is  necessary,  and 
other  processes  are  not  only  superfluous  but  in- 
convenient to  the  general  practitioner. 


42  SPRINGTIME  SURGERY 

The  operation  is  carried  out  in  as  simple  a  rou- 
tine method  as  possible,  keeping  in  mind  at  all 
times  these  three  dangers,  viz.,  casting  accidents, 
prolapse  of  the  bowels  and  infection. 

Equipment. — The  necessary  equipment  for  the 
operation  consists  of  the  following:  A  casting 
outfit,  scalpel,  emasculator  and  ecraseur,  operat- 
ing sheets,  green  soap,  tablets  of  bichloride  of 
mercury,  finger-nail  brush,  sterile,  dry  gauze 
packs  in  a  sterile  container,  a  trocar,  a  one-quart 
bottle,  and  a  large  needle  and  suturing  material, 
preferably  linen  tape  one-fourth  inch  broad. 

Casting. —  For  the  sake  of  uniformity  of 
method  all  patients  should  be  operated  upon  in 
the  casting  harness.  The  operating  table  offers 
no  advantages  and  is  not  always  at  hand.  The 
casting  harness  to  use  is  the  one  that  you  are  fa- 
miliar with,  providing  you  are  skilled  in  its  use 
and  can  adapt  it  to  the  operation.  Properly  con- 
fining the  animal  is  a  larger  question  than  the 
actual  operation,  since  upon  it  depends,  not  only 
one's  success  in  satisfactorily  performing  the 
operation,  but  also  the  danger  of  casting  acci- 
dents, and  to  a  degree  the  dangers  of  prolapse  of 


PRACTICAL  CRYPTORCHID  CASTRATION      43 

the  bowels  and  of  peritoneal  infection.    The  re- 
quirements of  such  a  harness  are : 

1.  It  must  hold  the  animal  firmly  so  that  no 
change  of  position  is  possible. 

2.  All  four  legs  and  especially  the  hind  legs 
must  be  fully  flexed  upon  themselves  and  held  so 
firmly  that  change  of  position  is  impossible. 

3.  The  hind  legs  must  be  held  by  the  harness 
in  a  widely  abducted  position  with  the  legs  so 
flexed  that  the  hoof  is  just  slightly  in  advance  of 
the  stifle. 

I  cannot  emphasize  too  strongly  the  impor- 
tance of  this  latter  requirement.  One  should 
study  and  practice  the  art  of  casting  until  he  is 
perfect  in  it ;  too  many  failures  in  surgical  opera- 
tions are  the  direct  result  of  bunglesome  and  im- 
perfect tying. 

The  operating  sheets  mentioned  in  the  list  of 
articles  needed  for  the  operation  have  served  me 
very  valuable  purposes  and  saved  me  much  time 
and  annoyance  during  operation.  They  are 
merely  muslin  sheets  one  and  one-half  yards 
square,  some  of  which  have  central  oval  openings 
seven  inches  long  by  one  inch  wide. 


44  SPRINGTIME  SURGERY 

Plan  of  Procedure.— The  details  of  conduct- 
ing an  operation  in  the  country  are  about  as  fol- 
lows :  Upon  arriving  at  the  place  of  operation  a 
spot  for  casting  is  selected.  There  are  no  par- 
ticular specifications  regarding  a  casting  site  ex- 
cept that  it  be  level  and  of  sufficient  size.  A  grass 
plot  is  best,  although  not  indispensable.  A  clean 
operation  can  be  done  anywhere,  but  more  care 
is  required  in  dirty,  dusty  surroundings.  When 
the  casting  site  is  selected,  the  owner  is  directed 
to  procure  a  pail  of  warm  water  and  a  basin  and 
to  have  the  patient  brought  out.  While  this  is  be- 
ing done  the  operator  prepares  his  equipment  for 
the  operation.  The  scalpel,  emasculator,  ecras- 
eur  and  needle,  threaded  with  a  piece  of  tape  fif- 
teen inches  long,  all  previously  sterilized  by  boil- 
ing, are  laid  out  on  a  clean  (if  not  sterile)  towel 
on  some  improvised  table,  as  a  board,  box  or 
medicine  case.  The  quart  bottle  is  filled  with 
water  and  to  it  is  added  enough  mercuric  chloride 
tablets  to  make  a  solution  of  1-1,000  or  even 
1-500.  The  can  of  sterile  gauze,  the  nail  brush, 
soap  and  operating  sheets  are  placed  conveniently 
near.    The  horse  is  then  cast  and  tied,  the  opera- 


PRACTICAL  CRYPTORCHID  CASTRATION      45 

tor  (who,  in  country  practice,  must  do  the  tying 
as  a  rule) ,  wearing  gloves  to  protect  his  hands  to 
a  certain  degree  from  contamination.  Chloro- 
form is  not  used. 

After  the  animal  has  been  cast  and  properly 
tied  for  the  operation,  is  the  time  to  make  the 
examination  if  a  diagnosis  of  side  is  necessary. 
Of  course,  this  is  a  question  that  needs  attention 
only  when  one  testicle  has  been  removed  and 
there  is  a  scar  on  both  sides  of  the  scrotum.  The 
side  from  which  the  testicle  has  been  removed 
can  be  told  in  all  cases  by  the  presence  of  the 
stump  of  the  cord  or  the  spermatic  fascia  in  the 
scrotum  or  inguinal  canal  of  that  side  except  in 
cases  where  the  testicle  removed  was  an  abdom- 
inal testicle,  when  there  will  be  no  stump  pres- 
ent. These  cases  are  rarely  met  with,  and  a  posi- 
tive diagnosis  of  the  side  can  be  made  only  by 
abdominal  exploration  during  the  operation. 
Ordinarily  when  one  testicle  is  removed  it  is  a 
descended  testicle  and  its  removal  leaves  a  stump 
in  the  scrotum  and  inguinal  canal  that  can  be 
easily  determined  by  careful  examination.  The 
history  by  the  owner  is  usually  of  no  value  and 


46  SPRINGTIME  SURGERY 

the  character  of  the  scrotal  scar  means  nothing. 
As  the  operation  proceeds  the  operator  further 
satisfies  himself  as  to  his  diagnosis  as  will  be 
mentioned  hereafter. 

A  determination  of  the  side  having  been  made, 
the  patient  is  placed  in  a  position  half  way  be- 
tween a  lateral  and  dorsal  decubitus,  with  the 
operative  field  uppermost.  This  is  usually  best 
accomplished  by  placing  the  horse  in  a  lateral  po- 
sition and  then  by  means  of  a  rope  noose  on  the 
upper  hock  have  an  assistant  apply  a  little  trac- 
tion as  if  to  roll  the  patient  over  on  its  back. 
This  not  only  places  the  patient  in  a  good  position 
but  abducts  the  upper  limb  and  improves  the  con- 
dition of  the  operative  field  and  thus  facilitates 
the  operation. 

Cleansing  the  Field  of  Operation.— The  next 
question  for  the  operator  to  concern  himself  with 
is  that  of  the  aseptic  preparation  of  the  opera- 
tive field.  An  appreciative  mind  will  understand 
that  all  the  dangers  of  this,  as  well  as  any  other 
surgical  operation,  are  increased  by  prolonging 
the  period  of  the  operation.  Consequently  the 
period  from  the  time  the  casting  harness  is  put 


PRACTICAL  CRYPTORCHID  CASTRATION      47 

on  the  patient  until  the  animal  is  again  up  and 
in  its  stall  should  be  as  short  as  is  consistent  with 
good  surgical  principles.  The  process  of  asepti- 
cizing the  operative  field  is  one  in  which  much 
time  can  be  saved  by  a  study  of  the  conditions. 
Excessive  scrubbing  and  cleansing  is  not  only 
without  results  of  value  but  often  productive  of 
conditions  exactly  opposite  to  those  at  the  pro- 
duction of  which  the  process  is  aimed.  Absolute 
asepsis  can  not  be  obtained  in  veterinary  practice 
except  at  a  great  outlay  of  expense  and  trouble 
that  is  not  justifiable.  In  cryptorchid  operations 
relative  asepsis  is  all  that  is  needed  for  success- 
ful work.  Peritoneal  infection  and  scrotal  infec- 
tion are  the  least  of  my  fears  when  operating.  A 
good  rule  is  to  be  as  aseptic  as  the  conditions 
will  allow  without  endangering  your  patient  by  a 
prolonged,  bunglesome  technic  (and  without  los- 
ing money  on  the  operation). 

The  method  that  I  follow  in  country  work  in 
preparing  the  operative  field  requires  from  two  to 
five  minutes,  the  length  of  time  consumed  depend- 
ing on  whether  it  is  done  by  myself  or  by  an  as- 
sistant while  I  am  scrubbing  my  hand^.     The 


48  SPRINGTIME  SURGERY 

process  consists  of  scrubbing  the  scrotal  area 
only,  with  green  soap  and  water  until  it  is  free 
from  visible  dirt.  The  upper  foot,  leg  and  thigh 
are  then  encased  in  an  operating  sheet  which  is 
clean  (not  sterile)  and  which  is  applied  in  a  few 
seconds  of  time,  being  made  so  as  to  fit  the  parts 
and  supplied  with  proper  means  of  attachments. 
This  protects  the  field  against  serious  contamina- 
tion from  that  source.  The  lower  leg  may  be 
covered  in  a  like  manner,  but  this  is  rarely  neces- 
sary. The  soap  and  water  scrubbing  is  confined 
to  a  small  area  of  the  scrotum  at  the  point  where 
the  incision  is  to  be  made.  This  is  important. 
Uncleaned  areas  near  the  field  of  operation  are 
covered  by  a  sheet  and  are  just  as  removed  from 
the  operation  as  if  they  were  on  another  animal. 

The  soap  and  water  scrubbing  over,  and  the 
two  hind  legs  encased  in  protective  sheets,  the 
operator  proceeds  to  scrub  his  hands  and  arms, 
paying  particular  attention  to  the  hand  that  is  to 
be  inserted  into  the  belly  wall.  Relative  asepsis 
only  is  aimed  at  by  a  one-  to  three-minute  scrub- 
bing of  the  hands  with  the  brush  and  green  soap, 
followed  by  a  short  scrub  in  the  bichloride  solu- 


PRACTICAL  CRYPTORCHID  CASTRATION      49 

tion.  This  being  done,  the  operator  with  clean 
hands  gives  a  short  final  scrub  to  the  operative 
field  which  is  then  subjected  to  an  application  of 
the  bichloride  solution  and  an  operative  sheet 
spread  over  the  belly  and  scrotal  region  so  that 
the  opening  comes  over  the  line  where  the  in- 
cision is  to  be  made.  The  area  of  the  incision  is 
then  painted  with  tincture  of  iodine,  a  quick, 
practical  and  efficient  means  of  producing  sur- 
face asepsis. 

The  Incision. —  The  routes  by  which  the  ab- 
dominal cavity  is  entered  by  cryptorchid  cas- 
trators  may  be  clased  into  three  general  groups, 
viz.: 

1.  Through  the  inguinal  canal. 

2.  Directly  through  the  belly  wall  in  the  neigh- 
borhood of  the  internal  ring. 

3.  Directly  through  the  belly  wall  in  the  upper 
flank  region. 

There  are  a  number  of  varieties  of  each  group, 
each  of  the  numerous  operators  varying  the 
process  to  suit  his  individual  taste. 

The  method  that  I  prefer  is  the  inguinal  canal 
route.     The  technic  of  entering  the  abdominal 


50  SPRINGTIME  SURGERY 

cavity  by  this  route  is  as  follows:  An  incision, 
five  or  six  inches  long,  is  made  through  the 
scrotum  parallel  with  and  one  or  two  inches 
from  the  median  raphe.  This  incision  is  carried 
through  the  skin  and  dartos  into  the  scrotal  sac. 
When  this  is  done  the  scalpel  is  laid  aside  and  the 
remainder  of  the  process  is  carried  out  entirely 
by  blunt  dissection  with  the  fingers.  The  scro- 
tum is  found  to  contain  considerable  areolar 
fascia  and  a  mass  of  blood  and  lymph  vessels. 
No  attention  is  paid  to  these ;  they  are  pulled  this 
way  or  that,  until  an  opening  is  made  through 
them  down  to  the  external  ring  of  the  inguinal 
canal,  which  is  but  an  oval  slit  through  the  apo- 
neurosis of  the  external  oblique  muscle,  large 
enough  to  freely  to  admit  the  operator's  hand. 
This  muscle  is  located  just  in  front  of  the  pubis 
and  at  the  side  of  the  prepubian  tendon,  land- 
marks that  are  easily  determined.  The  exposure 
of  this  ring  and  the  introduction  of  the  hand  into 
it  is  a  matter  of  no  difficulty.  The  fingers  of 
both  hands  are  used  in  the  dissection  up  to  this 
point.  Now  but  one  hand  is  required  to  finish 
the  opening. 


PRACTICAL  CRYPTORCHID  CASTRATION      51 

Traversing  the  Inguinal  Canal.— The  oper- 
ator places  himself  so  that  he  is  facing  the  field 
of  operation  and  uses  the  right  hand  if  it  is  the 
left  testicle  that  is  retained  and  vice  versa.  The 
hand  used  is  inserted  through  the  scrotal  incision 
and  through  the  external  inguinal  ring  into  the 
inguinal  canal.  The  fingers  of  the  hand  should 
be  bunched  and  directed  toward  the  internal  in- 
guinal ring,  to  which  they  are  gradually  forced, 
separating  the  muscular  belly  of  the  internal  ob- 
lique muscle,  which  lies  on  the  palm  or  side  of 
the  hand,  from  the  aponeurosis  of  the  external 
oblique  muscle  and  Poupart's  ligament  which  lies 
OH  the  back  of  the  hand.  While  the  introduc- 
tion of  the  hand  through  the  external  ring  and 
into  the  canal  is  always  an  easy  matter,  the  pass- 
ing of  the  hand  up  the  canal  in  the  proper  direc- 
tion and  the  locating  of  the  internal  ring  is,  to  the 
uninitiated,  usually  attended  with  more  or  less 
difficulty.  The  direction  to  go  is  deep  into  the 
fold  of  the  groin,  keeping  back  against  Poupart's 
ligament  and  the  thigh  muscles. 

Most  beginners,  I  have  found,  have  trouble  in 
locating  the  internal  ring  because  of  two  chief 


52  SPRINGTIME  SURGERY 

mistakes.  One  is  in  keeping  too  far  forward  and 
the  other  is  in  being  afraid  to  insert  the  hand  far 
enough  up  the  canal.  I  therefore  try  to  empha- 
size the  importance  of  going  high  up  into  the 
groin  and  keeping  back  against  the  thigh  when 
forcing  the  hand  up  the  canal. 

Locating  the  Internal  Inguinal  King. — 
After  the  canal  has  been  traversed  by  the  hand 
the  selection  of  a  spot  for  the  opening  into  the 
belly  is  the  next  thing  of  importance.  There  are 
four  places  that  may  be  used  and  are  used  by 
various  operators. 

1.  Through  the  internal  ring. 

2.  Below  the  internal  ring. 

3.  In  front  of  the  internal  ring. 

4.  Above  the  internal  ring. 

No  matter  what  position  is  selected  for  the 
opening,  the  wise  operator  will  first  locate  the  in- 
ternal inguinal  ring  as  a  starting  point.  This 
ring  represents  the  upper  end  of  the  inguinal 
canal.  After  the  hand  has  been  forced  up  the 
canal  to  a  point  beyond  the  upper  border  of  the 
internal  oblique  muscle  the  operator  finds  that 
only  a  relatively  thin  structure  separates  his 


PRACTICAL  CRYPTORCHID  CASTRATION      63 

fingers  from  the  abdominal  viscera,  which  can  be 
felt  more  or  less  clearly.  This  thin  membrane 
consists  of  two  chief  parts  or  layers.  These  are, 
first,  the  general  fascial  lining  of  the  abdomen, 
which  is  often  designated  as  the  transversalis 
fascia  and  is  spread  out  as  a  lining  of  the  entire 
abdomen  and  pelvis,  and,  second,  the  peritoneum. 
In  the  animal  with  the  testicle  undescended  the 
internal  ring  is  not  an  opening  or  a  slit  as  it  is 
sometimes  said  to  be  but  it  is  merely  a  thinned- 
out  area  of  the  above  mentioned  transver- 
salis fascia,  this  area  being  bordered  and  limited 
in  front  and  below  by  an  arched  band  of  con- 
nective tissue  which,  after  the  descent  of  the 
testicle  through  the  fascia  at  this  point,  forms 
the  true  ring.  The  upper  and  posterior  borders 
of  the  thinned-out  area  of  the  fascia  have  no 
limiting  band  of  fibers  and,  as  a  matter  of  fact, 
in  the  ridgling  the  area  is  not  defined  at  all  in 
these  two  directions.  (The  anatomical  facts  may 
be  beautifully  demonstrated  by  a  dissection  of  a 
seven  or  eight-months'  fetus.)  Consequently,  the 
operator,  in  searching  for  the  internal  ring,  does 
not  feel  for  a  slit-like  opening,  but  searches  for  a 


54  SPRINGTIME  SURGERY 

thin  portion  of  the  membrane  which  presents  an 
arched,  limiting  band  of  fibers  in  front  and  below. 
This  band  may  often  be  demonstrated  externally 
by  deep  palpation  in  the  middle  of  the  fold  of  the 
groin.  Its  determination  with  the  hand  in  the 
canal  is  a  matter  of  little  difficulty. 

In  a  great  many  cryptorchids  the  testicle  or 
epididymis  has  partially  descended  through  this 
area  and  one  may  find  a  condition  of  affairs  vary- 
ing from  a  mere  looseness  of  the  fascia  in  the 
area  to  a  finger-like  projection  of  it  containing 
the  tail  or  more  of  the  epididymis.  Ofttimes  the 
tail  of  the  epididymis  has  descended  through  this 
area  and  the  band  of  fibers,  which  normally  con- 
tracts after  natural  descent  of  the  testicle,  has 
contracted  down,  constricting  the  testicular  struc- 
tures so  that  the  globus  minor  of  the  testicle  is 
below  the  band  and  the  globus  major  and  the 
body  of  the  testicle  is  above  and  within  the  ab- 
dominal cavity  and  unable  to  descend  further. 

The  internal  ring,  or  better,  this  area  in  the 
transversalis  fascia,  lies  just  anterior  to  the  shaft 
of  the  ilium  at  about  its  middle  and  the  fascia  just 
behind  the  ring  is  reflected  backward  into  the 


PRACTICAL  CRYPTORCHID  CASTRATION      (i 

pelvis  where  it  becomes  the  pelvic  fascia  and 
where  it  is  more  or  less  firmly  anchored.  I,  there- 
fore, often  consider  the  internal  ring  in  the  ridg- 
ling  as  being  a  thin  area  in  the  transversalis 
fascia  bordered  anteriorly  and  inferiorly  by  this 
arched  band  of  fibers  and  posteriorly  and  supe- 
riorly by  the  shaft  of  the  ilium,  around  which  the 
fascia  is  reflected  into  the  pelvis  and  to  which  it  is 
more  or  less  intimately  attached.  This  area  as  de- 
fined is  just  about  large  enough  to  admit  a  hand 
with  ease.  The  recognition  and  protection  of  the 
integrity  of  the  borders  of  this  internal  ring  is  a 
matter  of  much  importance  in  the  operation. 

In  the  process  of  passing  the  hand  up  the  canal 
and  in  locating  the  internal  ring,  the  operator 
may  inform  himself  concerning  a  number  of 
things.  If  it  is  a  second  operation  he  may  ob- 
serve by  the  scar  tissue  how  far  up  the  inguinal 
canal  the  previous  operator  went  and  where  and 
whether  or  not  he  entered  the  abdominal  cavity. 
If  a  diagnosis  of  side  has  been  made,  the  operator 
while  in  the  canal  confirms  it  by  the  absence  of 
the  cord  stump  in  the  canal.  One,  of  course,  ob- 
serves whether  or  not  the  testicle  or  any  part  of 


56  SPRINGTIME  SURGERY 

it  has  descended  into  the  canal,  producing  a  com- 
plete  or  partial   flanker.     If  it   is   a   complete 
flanker,  all  of  the  testicle  having  passed  through 
the  inner  ring,  the  case  is  handled  as  a  plain  colt. 
If  only  a  part  of  the  testicle  is  descended,  ignore 
the  condition  and  operate  as  a  ridgling,  making 
the  opening  at  the  usual  point.    In  the  partially- 
descended  testicle  it  is  almost  always  the  tail  of 
the  epididymis  that  has  descended  and  the  ring 
ha3  contracted  down  around  it  so  that  the  testicle 
cannot  pass  through  and  usually  cannot  be  pulled 
through  with  safety  to  the  ring.    I  have  found 
that  these  are  best  handled  by  passing  up  along 
the  side  of  the  descended  tail  and,  making  the 
opening  at  the  usual  place,  pulling  the  descended 
portion  back  into  the  belly  and  out  the  opening. 
Opening     the      Peritoneal      Cavity.—  I    have 
satisfied  myself  that  the  best  place  to  open  into 
the  peritoneal  cavity  from  the  upper  end  of  the 
canal  is  at  a  point  just  in  front  of  the  shaft  of 
the  ilium,  at  the  upper  part  of  the  internal  in- 
guinal ring.    In  operating,  I  locate  the  internal 
ring  and  then  proceed   upward  and  somewhat 
backward  until  I  come  to  the  point  where  the 


PRACTICAL  CRYPTORCHID  CASTRATION      57 

fascia  passes  back  into  the  pelvis  and  here  I 
thrust  two  fingers  through  into  the  belly  cavity. 
In  making  the  opening  one  must  remember  that 
there  are  two  layers  to  go  through,  the  fascia  and 
the  peritoneum.  Sometimes  the  peritoneum 
pushes  ahead  of  the  fingers  and  strips  off  of  the 
wall  and  requires  a  special  effort  to  puncture. 
This  is  particularly  true  in  older  horses  and  in 
s3cond  operations  where  age  and  inflammation 
have  thickened  and  toughened  the  peritoneum. 
It  is  also  more  apt  to  occur  in  the  horses  with 
empty  intestinal  tracts. 

Before  leaving  the  subject  of  the  opening  into 
the  belly  I  wish  to  emphasize  one  thing.  Preserve 
the  integrity  of  the  band  of  fibers  that  bounds 
the  internal  ring  anteriorly  and  inferiorly.  This 
band  is  not  easily  torn,  but  in  the  use  of  force  in 
extracting  the  testicle  or  in  other  manipulations, 
see  to  it  that  no  great  tension  is  thrown  upon  it. 
So  long  as  this  band  is  intact  the  rent  in  the  fascia 
is  limited  by  it.  If  it  is  torn  across,  any  increase 
in  the  intra-abdominal  pressure  may  cause  it  to 
tear  farther  down  and  the  protection  against  pro- 
lapse of  the  bowel  is  lost.    In  all  cases  where  an 


58  SPRINGTIME  SURGERY 

enlargement  of  the  opening  is  necessary  make  it 
upward  and  backward ;  never  by  use  of  the  knife 
or  other  means  enlarge  the  opening  in  the  other 
directions.  If  one  finds  a  testicle  so  large  t^at 
it  cannot  be  forced  out  through  this  area  with- 
out endangering  this  band  of  fibers,  then  it  is  too 
large  a  testicle  to  be  removed  through  the  in- 
guinal region.  This  is  too  dependent  a  portion  of 
the  belly  wall  for  large  openings  at  any  point. 
My  method  of  handling  such  cases,  which  fortu- 
nately are  very  rare,  is,  if  the  testicle  cannot  be 
forced  through  the  opening  after  all  means  of 
reducing  its  size  (tapping  of  cysts,  etc.)  have 
failed,  to  discontinue  the  operation  at  this  point, 
allow  the  inguinal  wound  to  heal,  and  after  three 
or  four  weeks  remove  the  testicle  through  a  lapa- 
rotomy in  the  upper  flank  region. 

Locating  the  Testicle.—  We  will  presume 
that  the  operator  has  traversed  the  ing:uinal  cr.nal, 
located  the  internal  ring  area,  and  advanced  be- 
yond this  area  in  a  direction  upward  and  backward 
until  he  finds  his  fingers  against  the  pelvic  inlet 
at  the  middle  of  the  shaft  of  the  ilium,  and  at  this 
point  ha^  thrust  two  fingers  througfe  the  medium 


PRACTICAL  CRYPTORCHID  CASTRATION      59 

separating  his  hand  from  the  peritoneal  cavity. 
With  the  same  movement  by  which  the  opening  is 
made,  it  should  be  enlarged  to  a  size  sufficient  to 
admit  three  fmgers,  by  the  spreading  of  the  two 
fingers  that  have  been  used.  If  this  is  carried 
out  quickly  and  if  the  rent  made  is  held  open  by 
the  two  fingers  and  at  the  same  time  the  hand  is 
retracted  somewhat  so  as  to  make  an  empty  space 
in  the  upper  end  of  the  canal,  the  testicle  or  some 
part  of  its  cord  will  be  forced  out  into  the  palm 
of  the  hand.  This  will  occur  in  a  very  large  per- 
centage of  the  cases,  in  all  that  are  not  compli- 
cated by  adhesions  or  grossly  pathological  testicles. 

This  little  process  of  "coaxing"  the  testicle  out 
is  possible  only  when  the  animal  is  properly  tied, 
when  the  opening  is  properly  located,  when  the 
abdomen  is  not  too  empty,  and  there  is  an  intra- 
abdominal pressure,  and  when  the  animal  is  not 
anesthetized.  To  the  beginner,  with  some  doubt 
as  to  his  ability,  there  is  no  more  pleasant  sensa- 
tion than  that  produced  by  the  testicle  forcing 
itself  upon  him  and  down  the  canal. 

If  the  "coaxing"  process  fails  in  its  purpose 
after  a  few  seconds'  trial,  then  the  fingers  explore 


60  SPRINGTIME  SURGERY 

the  region  inside  the  opening.  The  cord  struc- 
tures pass  from  above  downward  in  close  juxta- 
position to  the  opening.  They  are  attached  to  the 
belly  wall  near  the  opening  and  consequently  can- 
not get  far  away.  More  often  they  are  right  be- 
neath the  finger  tips,  very  often  they  are  in  front 
of  the  opening  and  less  frequently  they  are  be- 
hind the  opening.  In  the  past  six  years  with  a 
large  series  of  cases  it  has  not  been  necessary  for 
me  to  introduce  the  entire  hand  into  the  abdomen 
to  locate  the  testicular  structures.  I  have,  in 
several  cases,  introduced  the  hand  into  the  abdo- 
men for  the  purpose  of  examining  pathological 
and  enlarged  testicles,  and  for  overcoming  cer- 
tain conditions  in  the  removal  of  testicles. 

No  Search  Necessary.—  With  due  attention  to 
the  entrance  into  the  abdomen,  search  for  the  tes- 
ticle is  eliminated.  It  is  right  at  the  finger  tips 
when  they  are  introduced.  The  only  thing  that 
is  necessary  is  to  be  able  to  recognize  the  differ- 
ence, by  sense  of  touch,  between  the  testicular 
structures  and  loops  of  bowel.  This  should  not  be 
difficult,  but  I  notice  that  some  are  unable  to  do 
it  with  certainty.    Examination  of  the  structures 


PRACTICAL  CRYPTORCHID  CASTRATION      61 

that  present  themselves  to  the  fingers  will  soon 
reward  the  operator  by  a  discovery  of  the  cord  or 
testicular  parts.  If  in  doubt,  bring  the  structure 
down  the  canal  and  examine  it  by  the  sense  of 
sight.  Remember  that  some  of  the  structures 
wanted  are  just  inside  the  opening  and  that  a 
little  patience  will  reveal  them. 

The  time-worn  quack  story  about  going  up  to 
the  diaphragm  and  the  spine  to  find  the  testicle 
is  to  be  forgotten.  It  is  for  the  edification  of  the 
laity  only.  I  have  never  found  it  of  value  to  use 
the  gubernaculum  as  a  guide  in  finding  the  testi- 
cle. Some  parts  of  the  epididymis,  cord  or  testicle 
presents  itself  invariably  upon  entering  the  peri- 
toneal cavity,  and  rarely  indeed  is  the  slightest 
search  required. 

Removal  of  the  Testicle.— The  testicular 
structures  having  been  located  and  recognized, 
they  are  brought  down  the  canal  and  removed. 
This  is  usually  an  easy  matter.  The  testicle  and 
epididymis  are  drawn  down  by  the  fingers  until 
an  emasculator  can  be  applied.  It  is  well  to  have 
at  hand  an  ecraseur  to  use  in  case  the  cord  struc- 
tures are  so  short  that  the  testicle  cannot  be 


62  SPRINGTIME  SURGERY 

drawn  far  enough  down  to  use  the  emasculator. 
One  can  use  an  ecraseur  in  all  cases  and  dispense 
with  the  emasculator  altogether,  but  I  have  found 
that  an  emasculator  can  be  used  in  about  ninety 
per  cent  of  the  cases  and,  being  a  much  quicker 
and  easier  method  than  the  other,  one  is  justified 
in  carrying  both  instruments  in  his  equipment.  In 
cutting  off  the  testicle  see  that  the  three  parts  are 
removed,  viz.,  body  of  the  testicle,  head  of  the 
epididymis  and  tail  of  the  epididymis.  These 
three  parts  are  often  far  separated  in  a  retained 
testicle  and  it  is  well  to  see  that  they  are  all  in- 
cluded in  the  parts  removed. 

"Cutting  'Em  Proud"  a  Fake.— I  might  say 
in  this  connection,  that  the  old  idea  that  leaving 
on  the  stump  of  the  cord,  a  part  of  the  epididymis 
would  influence  the  nervous  and  physical  develop- 
ment of  the  animal  and  give  to  it  the  characteris- 
tics of  a  stallion  cannot  be  substantiated.  The 
influence  that  the  testicles  have  upon  the  physi- 
cal and  temperamental  development  of  the  ani- 
mal depends  upon  an  internal  secretion  elabo- 
rated by  these  organs,  absorbed  into  the  blood 
and  lymph  channels  and  exerting  its  influence,  in 


PRACTICAL  CRYPTORCHID  CASTRATION      63 

harmonious  relation  to  other  internal  secretions, 
upon  the  activity  and  metabolism  of  the  various 
systems  of  organs.  This  internal  secretion  is 
elaborated  largely  if  not  entirely  by  groups  of 
epithelial  cells  embedded  in  the  stroma  of  the 
body  of  the  testicle  and  not  found  in  any  part  of 
the  epididymis.  I  have  satisfied  myself  on  the 
proposition  by  leaving  the  epididymis  in  a  few 
castrated  animals  with  negative  effect. 

Complications  That  May  Exist.—  Occasion- 
ally more  or  less  difficulty  is  met  with  in  bringing 
the  testicle  through  the  opening  and  down  the 
canal.  When  one  has  located  the  cord  and  moder- 
ate traction  on  it  fails  to  bring  the  testicle  into 
the  canal  it  is  due  to  one  of  the  following  causes : 

1.  An  enlarged  testicle,  which  hangs  heavily 
over  the  border  of  the  ring. 

2.  A  partially  descended  testicle,  the  tail  of 
which  is  gripped  by  the  contracted  ring  (this,  of 
course,  should  have  been  recognized  previously). 

3.  Adhesions  of  the  testicle  to  the  abdominal 
wall  at  some  point. 

In  the  presence  of  any  of  these  complications 
the  first  thing  to  do  is  to  examine  and  diagnose 


64  SPRINGTIME  SURGERY 

the  complicating  conditions.  The  cord  which  has 
been  grasped  and  pulled  down  into  the  canal  is 
held  by  the  fingers  of  the  free  hand  or  by  a  pair 
of  heavy  forceps.  The  hand  in  the  canal  is  then 
passed  up  along  the  cord  and  with  the  fingers,  or 
if  need  be  the  entire  hand,  in  the  peritoneal  cavity 
the  structures  are  examined,  remembering  that 
the  testicle  is  attached  to  the  lower  end  of  the 
doubled  cord  in  the  inguinal  canal  and  that  by  fol- 
lowing this  out  the  testicle  will  be  reached.  Oc- 
casionally it  may  be  best  to  turn  the  cord  loose, 
especially  if  the  entire  hand  i3  inserted  into  the 
abdomen.  Cases  of  these  kinds  are  fortunately 
rare  and  when  one  is  met  a  little  patience  on  the 
part  of  the  operator  will  allow  him  to  make  a 
positive  diagnosis  of  the  complicating  condition. 

The  treatment  of  adherent  testicles  is  obvious. 
The  adhesions  are  broken  up  and  the  testicle 
brought  down.  In  the  cases  in  which  the  tail  of 
the  epididymis  has  descended  through  the  internal 
ring  and  is  in  the  grasp  of  the  ring  the  treatment 
consists  in  pulling  it  back  into  the  belly  and  out 
through  the  opening  and  down  the  canal.  The 
handling  of  enlarged  testicles  is  a  subject  of  more 


PRACTICAL  CRYPTORCHID  CASTRATION      65 

importance.  From  a  practical  standpoint  the  en- 
larged testicles  may  be  divided  into  two  classes, 
viz.,  cystic  and  solid,  the  former  admitting  of  a 
reduction  in  size  by  tapping.  Upon  the  discovery 
of  an  enlarged  testicle  during  the  progress  of  the 
operation  the  operator  settles  two  questions  in  his 
mind.  First,  is  the  testicle  small  enough  to  pass 
out  through  the  ring  safely?  This,  however, 
varies  greatly  in  different  cases  and  the  operator 
is  the  judge  of  the  possibilities  in  a  given  case. 
Second,  is  the  testicle  cystic?  If  so,  it  is  tapped 
through  the  inguinal  canal  with  a  long  trocar. 
The  technic  is  as  follows:  An  assistant,  not 
necessarily  but  best  a  skilled  assistant,  empties 
the  rectum  of  the  patient  and  inserts  the  hand  into 
the  same  as  far  forward  as  possible.  By  the  direc- 
tions and  assistance  of  the  operator,  the  assistant, 
by  rectal  manipulation,  pushes  the  testicle  up 
against  the  internal  ring  and  holds  it  there  firmly 
by  pressure  from  behind.  The  operator  then  in- 
serts a  trocar  up  the  canal,  and  it  is  usually  an 
easy  matter  to  draw  off  the  cystic  fluid.  The 
rectal  manipulation  of  an  assistant  is  of  great 
value  also  in  the  withdrawal  of  a  large  testicle 


66  SPRINGTIME  SURGERY 

through  the  internal  ring.  Where  the  mass  is  so 
large  that  there  is  difficulty  and  danger  in  pulling 
it  through  the  ring  by  traction  on  the  cord  alone, 
then  an  assistant  working  through  the  rectum  can 
be  of  great  assistance.  He  can  force  the  testicle 
through  the  ring  in  a  manner  that  is  much  safer 
than  that  of  pulling  it  through  and  much  larger 
testicles  can  be  removed  safely  by  such  means 
than  can  be  removed  by  pulling  alone. 

Laparotomy  May  Be  Necessary.— If  the  ex- 
amination or  repeated  trials  demonstrates  the 
fact  that  the  testicle  is  too  large  to  be  safely  re- 
moved through  the  inguinal  canal  and  its  size  can- 
not be  reduced  by  tapping  or  other  means,  then 
there  is  but  one  thing  to  do.  Discontinue  the  at- 
tempts at  removal,  dress  the  wound,  allow  the 
patient  to  rise,  and  wait  a  couple  of  weeks  until 
the  inguinal  wound  is  healed  and  then  take  the 
testicle  out  through  a  laparotomy  opening  in  the 
upper  flank.  One  might  argue  at  this  point  that 
a  rectal  exploration  preceding  the  attempted  oper- 
ation would  have  made  unnecessary  the  exposure 
of  the  patient  to  the  dangers  attending  the  abdom- 
inal exploration,    but  this  is  not  true.    I  have  yet 


PRACTICAL  CRYPTORCHID  CASTRATION      67 

to  see  the  man  who  is  positive  enough  in  his  find- 
ings by  rectal  examination  to  gamble  on  his  diag- 
nosis. Abdominal  exploration  is  certain  in  its  re- 
sults and  the  dangers  are  practically  nil  when  one 
practices  good  technic. 

The  tapping  of  cystic  testicles  is  not  attended 
by  any  danger.  The  contents  of  these  cysts  is 
sterile  and  leakage  into  the  peritoneal  cavity  is  of 
no  consequence.  I  remember  of  but  one  report  in 
the  literature  of  an  infected  testicular  cyst.  They 
are  so  rare  as  to  be  of  negligible  import. 

Wound  Treatment  -After  the  testicle  has  been 
disposed  of.  The  dressing  of  the  wound  is  to  be 
undertaken.  This  is  simple.  It  is  best  explained 
by  emphasizing  a  few  things  that  it  is  important 
not  to  do. 

Do  not,  at  any  time,  introduce  any  kind  of  anti- 
septic or  aseptic  fluids  into  the  inguinal  ca.ial. 
From  the  time  the  operator  takes  his  scalpel  to 
make  the  scrotal  incision  until  the  operation  is 
completed,  clean  methods  are  important,  but  anti- 
septic solutions  within  the  abdomen  are  tabooed. 

Do  not  at  the  end  of  the  operation  remove  the 
blood  from  the  wound.    There  is  no  hemorrhage 


68  SPRINGTIME  SURGERY 

of  any  consequence  and  it  is  seldom  that  one  needs 
to  ligate  a  bleeding  point.  The  only  hemorrhage 
that  one  can  have  is  from  the  vessels  of  the  dartos 
and  they  are  small.  Hemorrhages  from  the  stump 
of  the  cord  is  practically  unimportant  except  oc- 
casionally in  pathological  testes,  in  which  case  one 
can  ligate  before  cutting  off  with  the  crushing  in- 
struments. 

Do  not  introduce  a  pack  of  any  size  into  the 
inguinal  canal.  I  believe  that  any  operation  that 
requires  the  canal  to  be  packed  is,  generally  speak- 
ing, a  failure.  Operating  by  the  foregoing 
method,  heeding  the  warnings  that  have  been 
given,  one  will  never  have  need  for  the  pack. 

The  opening  into  the  belly  that  is  described  in 
the  foregoing  is  a  self -protecting  one  against  es- 
cape of  the  viscera.  Of  course,  it  is  possible  for 
a  loop  of  bowel  to  come  down,  but  I  have  never 
had  such  to  occur.  A  dressing  of  the  wound 
that  is  to  be  recommended  is  as  follows : 

As  soon  as  the  testicle  is  disposed  of  a  small 
pack  of  dry  sterile  gauze  is  placed  in  the  scrotum 
and  the  scrotal  wound  is  sutured  by  a  continuous 
suture  of  the  linen  tape.    Its  chief  purpose  is  to 


PRACTICAL  CRYPTORCHID  CASTRATION      69 

absorb  by  capillarity,  the  juices  collecting  in  the 
wound  and  when  removed,  twenty-four  hours 
later,  to  leave  an  open,  well-drained  wound.  In 
suturing  the  wound  it  is  well  to  leave  the  ends  of 
the  sutures  long  so  that  they  hang  down  a  dis- 
tance of  four  or  five  inches.  This  facilitates  their 
removal.  The  owner  or  caretaker  of  the  patient, 
if  in  country  work,  is  shown  how  the  stitches  are 
put  in  and  how  and  when  to  remove  them. 

Accidents  Subsequent  to  Operation.-  The 
release  of  the  patient  from  the  casting  harness 
should  be  conducted  with  care.  The  period  of  re- 
lease and  until  patient  gains  his  feet,  if  attended 
by  struggling,  is  a  time  when  intestines  may  be 
forced  down  into  the  canal.  Consequently  this 
is  to  be  considered  one  of  the  danger  periods.  The 
ropes  must  be  removed  with  dispatch  and  removed 
quietly  so  as  not  to  excite  the  patient.  When  un- 
tied the  patient  is  given  assistance  in  arising  so 
that  awkward  movements,  as^  wide  abduction  of 
the  hind  limbs,  will  not  occur  to  open  up  the  canal 
and  tempt  intestinal  protrusion.  I  believe  that 
the  only  danger  of  intestinal  prolapse  with  the 
above  operation  is  when  the  animal,  carelessly 


70  SPRINGTIME  SURGERY 

forced  to  arise  by  the  operator,  awkwardly  stag- 
gers about  with  the  hind  limbs  widely  apart  and 
the  belly  muscles  tensely  contracted  in  its  attempt 
to  gain  a  balance.  Therefore,  care  at  this  time  is 
important. 

If  the  intestines  should  prolapse  at  this  time  (a 
thing  which  I  have  not  seen  with  this  operation, 
but  have  experienced  in  using  other  methods), 
the  scrotal  pack  and  sutures  will  protect  against 
all  dangerous  conditions  until  they  can  be  re- 
turned. With  the  internal  ring  intact,  as  soon  as 
the  animal  is  squarely  on  its  feet  there  will  be  a 
tendency  for  the  intestines  to  return  to  the  belly. 
This  may  be  assisted  if  necessary  in  two  ways. 
One  can  use  a  little  pressure  upward  on  the  in- 
guinal region  or  he  can  insert  the  hand  into  the 
rectum  and  by  sweeping  it  across  the  region  of  the 
internal  ring,  pull  the  intestines  back  into  the 
belly. 

After-Care.— The  after  treatment  of  the  pa- 
tient is  simple.  As  soon  as  he  is  released  he  is 
given  a  little  water  and  is  tied  in  a  comfortable 
place  and  in  such  a  manner  that  he  cannot  lie 
down.    He  is  allowed  a  moderate  ration  of  food 


PRACTICAL  CRYPTORCHID   CASTRATION      71 

and  is  kept  quiet  for  twenty-four  hours.  At  the 
end  of  this  time,  in  the  uncomplicated  cases,  the 
caretaker  removes  the  sutures  and  pack  after 
which  the  patient  is  treated  as  he  would  be  had 
he  been  a  straight  colt.  He  is  allowed  to  run  at 
large  or  is  given  plenty  of  exercise  and  a  full 
diet.  I  have  never  found  irrigation  or  other 
treatment  of  the  wound  necessary.  He  is  kept 
standing  only  twenty-four  hours. 

In  Conclusion. —  We  may  say  the  uncompli- 
cated case  requires  but  a  short  time  for  castra- 
tion and  is  but  little  affected  by  it.  These  cases 
will  feed  immediately  upon  being  tied  in  their 
stalls  and  there  are  no  post-operative  complica- 
tions of  any  sort  to  deal  with.  SweHings  of  the 
scrotum  and  prepuce  is  usually  less  in  evidence 
than  in  straight  colts  as  the  pack  produces  a  bet- 
ter draining  wound.  Peritonitis  is  an  evidence  of 
inexcusable  errors  and  carelessness  in  operating. 

Double  cryptorchids  are  quite  frequently  met 
with.  They  are  handled  as  the  single  ones.  Re- 
moval of  the  two  testicles  through  a  single  open- 
ing is  rarely  advisable.  Remembering  that  prac- 
tically all  cryptorchid  testicles  may  be  removed 


72  SPRINGTIME  SURGERY 

with  but  one  or  two  fingers  inserted  into  the  peri- 
toneal cavity,  one  can  see  that  the  opening  up  of 
the  second  inguinal  canal  would  be  far  less  in- 
jurious than  inserting  the  whole  hand  through 
the  belly  wall  in  the  attempt  to  bring  across  the 
second  testicle.  It  is  best  to  make  a  double  opera- 
tion, but  remove  both  testicles  at  one  casting. 

The  operation  where  entrance  to  the  peritoneal 
cavity  is  made  by  an  incision  directly  throug'  the 
belly  wall  in  the  neighborhood  of  the  internal  ring 
is  used  by  several  operators  and  with  success.  I 
have  not  found  it  as  satisfactory,  from  a  number 
of  standpoints,  as  the  inguinal-canal  route. 

An  operation  that  one  will  very  infrequently 
have  occasion  to  use  is  that  in  which  the  peri- 
toneal cavity  is  reached  through  its  triangle  of 
the  upper  flank.  This  operation  is  the  one  of 
election  when  a  large  testicle  is  to  be  removed. 
The  opening  is  made  at  a  point  where  it  can  be 
completely  controlled  from  a  surgical  standpoint, 
it  can  be  closed  and  protected  and  it  is  where 
danger  of  intestinal  prolapse  is  absent.  Opening 
the  belly  cavity  in  this  region  is  a  safe  procedure 
under  even  moderate  aseptic  conditions.    I  have 


PRACTICAL  CRYPTORCHID  CASTRATION      73 

had  occasion  to  use  it  in  cryptorchids  and  have 
repeatedly  used  it  in  spaying  mares.  The  time- 
honored  pronunciamento,  that  it  is  fatal  i% 
open  the  abdominal  cavity  of  the  horse,  belongs 
to  the  pre-Listerian  era  and  has  little  bearing 
on  modern  aseptic  surgery.  Successful  lapa- 
rotomy in  the  equine  depends  merely  upon  con- 
trolling the  concomitant  infection  of  the  peri- 
toneum, aside  from  which,  it  presents  no  serious 
difficulty. 

Young  patients  are  much  more  satisfactory  to 
operate  upon  than  older  ones.  One  should,  in 
studying  the  operation,  select  untouched  year- 
lings or  two-year-olds  for  his  first  patients,  the 
yearlings  being  preferable  to  the  two-year-olds. 

Complicating  conditions  in  young  patients  are 
exceedingly  rare;  in  older  ones  they  are  much 
more  common.  Adhesions,  hyperplastic  and 
cystic  testicles  and  the  partially  descended  and 
strangulated  testicles  are  all  results  of  age.  Older 
animals  are  more  difficult  to  confine  properly  and 
being  more  liable  to  present  complicating  con- 
ditions are  more  apt  to  suffer  from  the  accidents 
of  the  operation. 


74  SPRINGTIME  SURGERY 

To  the  beginner  I  would  recommend  that  he 
select  a  young  patient,  and  before  operating  care- 
fully map  out  his  plan  of  procedure.  Nothing 
counts  like  system  and  nothing  succeeds  like  the 
uniformly  systematic  man. 


Cryptorchidectomy  in  Horses* 

By  C.  E.  Steel,  D.  V.  S.,  Oklahoma  City,  Oklahoma 

Comparatively  few  of  us  have  the  opportunity 
to  castrate  cryptorchids  often  enough  to  become 
really  proficient  in  this  operation  and  yet  it  is  one 
that,  with  a  knowledge  of  the  anatomy  of  the 
part  concerned  in  the  operation  and  with  modern 
surgical  antiseptic  and  aseptic  measures  at  our 
command,  the  average  practitioner  should  not 
"side-step"  in  favor  of  the  so-called  specialist, 
who  often  is  anything  but  clean  and  scientific 
in  such  work. 

As  Dr.  L.  A.  Merillat  has  said:  "It  is  indeed 
remarkable  how  one  can  mutilate  a  ridgling  with 
impunity  in  the  frantic  search  for  a  well  hidden 
testicle,  if  the  parts  are  not  infected  in  the  effort." 
Most  of  us  know  of  one  or  more  empirics  who 
are  successful  ridgling  operators  in  spite  of  their 
uncleanly  methods  and  utter  ignorance  of  asepsis 


♦Reprinted  from  Missouri  Valley  Veterinary  Bulletin,  January,  1910. 


76  SPRINGTIME  SURGERY 

and  antisepsis.  When  we  compare  our  own 
efforts  with  such  men,  we  are  somewhat  inchned 
to  lose  faith  in  the  value  of  antiseptic  precau- 
tions and  to  lose  confidence  in  ourselves. 

From  long  practice,  professional  ridgling  cas- 
trators  become  expert  and  the  time  required  to 
perform  the  operation  with  them,  usually  amounts 
to  but  a  few  seconds  or  minutes  after  the  animal 
is  secured.  With  the  hands  of  the  skillful 
though  unscientific  operator  ordinarily  clean, 
the  peritoneum  is  far  less  likely  to  become  con- 
taminated than  with  the  inexperienced  operator, 
who  usually  employs  some  half-way  measures 
toward  securing  asepsis  and  frequently  hunts  for 
the  testicle  for  an  hour,  or  more,  and  sometimes 
even  then  fails  to  find  it,  much  to  his  own  em- 
barrassment and  humiliation.  The  obvious  de- 
duction is  supplant  lack  of  experience  by  the 
strictest  precautionary  measures  at  our  hands. 
In  fact,  however  skilled  one  becomes  he  should 
most  religiously  follow  the  technic  of  preparing 
the  operative  field,  instruments  and  hands,  as 
though  he  expected  to  search  indefinitely  for  the 
hidden  testicle. 


CRYPTORCHIDECTOMY  IN  HORSES  77 

The  following  is  about  the  routine  which  I 
have  employed  and,  I  may  say  considering  the 
number  it  has  been  my  lot  to  operate  upon  dur- 
ing the  past  few  years,  and  the  results  attained, 
it  seems  to  be  a  practical  method. 

I  first  apply  a  twitch  to  the  nose,  lightly,  and 
make  an  inguinal  examination  with  the  animal 
in  the  standing  position.  In  some  horses  in  good 
condition,  particularly  those  over  two  years  old, 
the  superficial  inguinal  lymphatic  glands  may 
deceive  one,  especially  in  nervous  or  ticklish  ani- 
mals, in  which  squeezing  these  glands  may  cause 
them  to  flinch,  much  as  would  pressure  upon  the 
testicle  itself.  The  importance  of  this  prelimi- 
nary step  is  considerable  in  some  cases,  as  many 
owners  of  ridgiings  are  not  willing  to  assume  the 
risk  incidental  to  the  operation,  and  the  veteri- 
narian's sense  of  touch  is  called  upon  to  decide 
whether  the  horse  is  an  abdominal  ridgling  or 
merely  a  **high  flanker. '  In  exceptional  cases  it 
may  be  necessary  to  caste  the  animal  to  make  a 
correct  diagnosis,  but  in  horses  thin  in  flesh  it  is 
an  easy  matter  to  determine  whether  they  are 
ridgiings. 


78  SPRINGTIME  SURGERY 

The  animal  is  prepared  for  the  operation  by 
withholding  feed  and  perhaps  water  for  a  period 
of  twenty-four  hours,  depending  somewhat  on 
his  condition ;  this  is  not  always  advisable,  as  cir- 
cumstances may  make  it  inconvenient  or  im- 
possible. For  casting  select  a  grassy  spot  away 
from  manure  heaps  and  other  insanitary  con- 
ditions usually  met  with  around  stables,  and  tie 
up  the  tail  securely.  With  a  modified  Conkey 
throwing  harness  and  a  hood  to  protect  the  eyes 
of  the  patient  cast  and  tie  him.  I  do  this  myself 
with  the  aid  of  one  man  at  the  head  and  another 
with  one  of  the  side-ropes.  But  it  is  preferable 
to  have  an  experienced  assistant  to  do  the  hand- 
ling of  harness  and  ropes,  and  tie  up  feet  with 
damp  cloths.  Having  previously  scrubbed  my 
hand3  with  a  brush  and  thoroughly  cleansed 
nails  with  water  and  soap  and  rinsed  well  in  a 
1-3,000  bichloride  solution,  have  an  emasculator, 
ecraseur,  curved  needles,  sterilized  silk,  artery- 
forceps,  and  convex  bistoury,  or  regulation  cas- 
tration knife  at  hand  in  one  per  cent  chinosol 
solution  in  a  clean  pan.  I  have  also  a  kettle  of 
boiled  water,  cooled  to  luke-warm  temperature,  a 


CRYPTORCHIDECTOMY  IN   HORSES  79 

clean  pan,  a  cake  of  soap  and  clean  towels  ready 
for  use  and  after  having  an  assistant  wet  down 
the  entire  abdomen  to  allay  flying  hairs  and  dust, 
1  have  the  scrotum  and  inguinal  region  scrubbed 
well  with  soap  and  water,  containing  any  relia- 
ble antiseptic,  then  thoroughly  rinsed  with  bichlo- 
ride solution,  1-3,000  strength.  If  I  have  had  to 
assist  in  the  castrating  (with  gloved  hands,  of 
course)  I  proceed  to  wash  my  hands  and  wrists 
in  same  strength  solution,  and  with  twitch  ap- 
plied to  the  patient's  nose,  make  a  four  or  five- 
inch  incision  about  one  inch  from  the  median 
line.  I  prefer  the  side  on  which  I  am  operating, 
uppermost.  In  making  the  incision  I  try  not  to 
go  deeply,  and  thus  avoid  wounding  the  large 
scrotal  veins  that  may  lie  in  such  a  tortuous  net- 
work that  it  is  hard  to  keep  from  cutting  them 
if  the  knife  goes  deep.  If,  however,  any  of  the 
larger  blood  vessels  are  severed,  it  is  not  a  diffi- 
cult matter  to  take  up  with  artery-forceps  and 
ligate,  a  thing  it  is  advisable  to  do  at  once. 

If  the  animal  has  not  been  operated  upon 
before,  it  is  an  easy  matter  to  break  or  tear  down 
the  fascia  in  an  outward  and  forward  direction 


80  SPRINGTIME  SURGERY 

for  a  distance  of  from  six  to  ten  inches,  depend- 
ing upon  size  and  condition  of  animal.  If,  how- 
ever, he  has  been  tampered  with,  the  cicatrical 
tissue  may  offer  considerable  resistance.  One 
should  use  judgment  though,  and  be  sure  to 
break  down  sufficient  tissue  to  insure  plenty  of 
working  room  for  the  hand,  so  as  not  to  tire  it  in 
succeeding  steps  of  the  operation. 

Having  penetrated  to  the  above-named  dis- 
tance, one  should  be  in  the  neighborhood  of  the 
internal  inguinal  ring,  which  is  recognized  by  a 
much  thinner  feeling  than  the  surrounding  parts. 
A  rotary  motion  of  the  hand  will  aid  in  reaching 
the  part,  and  some  operators  employ  sterilized  or 
antiseptized  oil  to  facilitate  the  process.  I  have 
never  used  oil.  When  my  fingers  have  reached 
the  peritoneum  covering  the  internal  inguinal 
ring  I  instruct  the  man  at  the  head  to  tighten 
the  twitch,  and  at  the  instant  of  full  inspiration  I 
perforate  it  with  either  index  or  second  finger 
or  both,  and  usually  contact  the  testicle  immedi- 
ately. In  many  cases,  however,  I  have  had  to 
search  or  finger  for  the  organ  or  the  vas  deferens 
for  varying  lengths  of  time,  but  in  no  case  have 


CRYPTORCHIDECTOMY  IN  HORSES  81 

I  found  it  necessary  to  insert  more  than  two 
fingers  into  the  abdominal  cavity  excepting  where 
a  cystic  formation  or  other  abnormality  was 
present. 

The  fecal  matter  in  the  floating  colon  is  not 
to  be  mistaken  for  the  testicle,  being  easily  dis- 
tinguished by  its  softer  consistency.  Mesenteric 
arteries  should  be  easily  recognized  by  their  dis- 
tinct pulsations  and  not  mistaken  for  the  vas 
deferens.  A  flabby,  undeveloped  testicle  and  epi- 
didymis, however,  closely  resemble  in  touch  the 
small  intestine.  In  a  number  of  cases  I  have 
withdrawn  the  small  bowel  to  the  outside  suffi- 
ciently to  recognize  it,  without  bad  after-effects. 
An  assistant  with  the  ability  to  recognize  a  tes- 
ticle through  the  rectal  wall,  can  sometimes 
render  valuable  aid  in  locating  the  missing  organ 
and  the  operator  should  resort  to  it  himself  with 
his  disengaged  hand  and  arm,  rather  than  keep 
the  animal  down  unnecessarily  long;  prompt  and 
careful  cleansing  of  the  hand  and  arm  by  an  as- 
sistant before  the  instrument  or  the  operating 
field   is   touched   during   the   remainder   of  the 


82  SPRINGTIME  SURGERY 

operation  will  usually  avoid  infection  from  the 
procedure. 

When  the  testicle  has  been  located  and  brought 
into  view  it  is  removed  either  with  an  emascu- 
lator  or  an  ecraseur  and  the  opening  into  the  abdom- 
inal cavity  carefully  examined  to  determine  the 
size  of  the  peritoneal  opening  and  make  abso- 
lutely sure  that  no  bowel  protrudes.  If,  by  any 
mischance,  a  larger  opening  has  been  made  than 
one  feels  safe  in  leaving,  even  when  no  intestines 
have  escaped,  I  prefer  to  pack  carefully  the  en- 
tire wound  and  stitch  the  packing  in  with  a  con- 
tinuous suture.  In  ordinary  cases,  such  packing 
is  not  necessary. 

In  releasing  the  animal,  I  prefer  to  have  him 
stand  quietly  for  from  six  to  twelve  hours.  If 
he  has  been  packed,  instruct  the  owner  how  to 
remove  the  gauze,  and  have  him  turned  to  grass, 
or  exercised  sufficiently  to  overcome  soreness. 
Should  swelling  occur  around  the  scrotal  wound, 
insist  strenuously  on  exercise,  first,  last  and 
every  time.  If  peritonitis  develops  after  such  an 
operation  as  described,  the  animal  is  doomed  to 
die,  in  nearly  all  cases,  in  spite  of  treatment. 


An  Interesting  Monorchid* 

By  Frederick  Hobday,  F.  R.  C.  V.  S.,  London,  England 

This,  a  two-year  old  chestnut  cart-horse,  be- 
longing for  Mr.  T.  Stainton,  M.R.C.V.S.,  was  of  es- 
pecial interest  as  it  proved  to  be  a  true  mon- 
orchid. There  was  no  evidence  or  history  of  any 
prior  attempt  at  castration ;  in  fact,  it  was  known 
with  certainty  that  no  testicle  had  ever  been  re- 
moved. The  left  one  was  present  in  the  scrotum 
and  was  removed  without  any  trouble.  On  the 
right  side  the  abdomen  was  penetrated  in  the 
usual  situation,  close  to  the  inguinal  ring,  and  a 
careful  search  revealed  not  only  the  absence  of 
testicle,  but  a  gradual  merging  of  the  end  of  a 
rudimentary  cord  into  the  lining  of  the  perito- 
neum of  the  pelvis.  After  making  sure  of  this 
by  tracing  it  repeatedly,  the  hand  was  withdrawn 
and  the  inguinal  canal  carefully  closed  by  sutures. 


♦Reprinted    from    the    American    Journal    of    Veterinary    Medicine, 
October,  1910. 


84  SPRINGTIME  SURGERY 

The  colt  was  allowed  to  come  out  of  his  anesthe- 
sia and  he  got  up  apparently  none  the  worse  for 
his  experience.  This  was  about  5  o'clock.  At 
10:15  p.  m.  the  animal  was  heard  to  be  making  a 
noise  in  the  box  as  if  in  violent  pain,  and  upon 
examination  the  bowels  were  found  to  have  de- 
scended. The  weight  had  ruptured  one  of  the 
sutures  and  a  loop  of  bowel  had  come  down  nearly 
as  far  as  the  hocks. 

Assistance  was  summoned,  and  after  consider- 
able difficulty  the  colt  was  cast  and  the  bowel  re- 
turned. As  much  washing  and  disinfecting  was 
done  as  was  possible  under  the  circumstances,  and 
a  plug  of  cotton  wool  was  inserted.  This  was  in- 
serted underneath  a  row  of  sutures,  and  then  fol- 
lowed by  a  second  row  of  sutures,  in  such  a  way 
that  the  pad  could  be  changed  without  danger  of 
allowing  the  bowel  to  escape,  the  first  layer  of 
sutures  not  being  touched  or  interfered  with  in 
any  way. 

On  the  following  morning  the  colt's  tempera- 
ture was  103°  F.,  and  during  the  subsequent  days 
it  varied  between  102°  and  103°  F.  The  pad  of 
cotton  wool  was  changed  on  numerous  occasions, 


AN   INTERESTING  MONORCHID  85 

and  febrifuges,  tonics,  or  stimulants  were  admin- 
istered internally  at  discretion.  Anti-strepto- 
coccic  serum  was  also  given. 

Peritonitis  was  evidently  present,  and  in  spite 
of  all  efforts  death  eventually  took  place  a  month 
after  the  operation. 

An  autopsy  at  v/hich  Dr.  Kendall,  D.  V.  S., 
M.  R.  C.  V.  S.,  and  Mr.  Benson,  M.  R.  C.  V.  S.,  in 
addition  to  Mr.  Stainton  and  myself  were  also 
present,  confirmed  the  absence  of  any  testicle  on 
the  right  side,  nor  was  there  any  evidence  of  such 
an  organ  ever  having  existed,  the  spermatic  cord 
being  clearly  traceable  and  merging  impercepti- 
bly into  the  peritoneum  of  the  pelvis.  Such  cases 
are  rare,  and  are  worth  recording.  I  have  already 
reported  a  similar  case  in  my  little  brochure  upon 
"Cryptorchid  Castration,"  and  a  further  still  more 
curious  point  in  which  both  testicles  were  absent. 

The  remainder  of  the  autopsy  was  of  interest 
only  in  connection  with  the  peritonitis.  The  loop 
of  bowel  which  had  descended  was  matted  to- 
gether, and  there  was  a  long  abscess  between  the 
two  portions  of  the  loop.  This  contained  a  piece 
of  dirty  straw  which  must  have  been  overlooked, 


86  SPRINGTIME  SURGERY 

as  it  quite  readily  might  have  been,  when  the 
bowels  were  washed  and  returned. 

On  the  left  side  the  end  of  the  cord  from  which 
the  testicle  had  been  removed  could  be  found 
quite  easily,  and  had  nothing  about  it  upon  which 
to  make  any  comment. 


A  Castrator's  Error'' 

J.  L.  Perry,  M.  R.  C.  V,  S.,  Cardiff,  Wales 
I  received  a  letter  asking  me  to  attend  a  cart 
horse,  aged  three,  upon  which  an  attempt  at  cas- 
tration had  been  made  by  an  unqualified  man 
three  days  previously. 

The  owner  said  in  his  letter:  "The  castrator, 
a  man  who  does  all  that  kind  of  work  about  here 
and  has  hitherto  been  most  successful,  ^bunched' 
up  something  in  the  clam.  I  saw  at  once  it  was 
not  a  testicle,  and  told  him  so.  He  insisted  that 
the  colt  was  malformed  and  that  it  was  the  other 
testicle  all  right.  I,  however,  left  in  disgust,  and 
learned  afterwards  that  he  had  at  once  proceeded 
to  sear  through  this  'something'  with  the  hot  iron, 
immediately  this  was  completed  about  twelve 
inches  of  penis  fell  from  the  horse's  sheath  to  the 
ground."  So  he  had  amputated  the  penis  in  mis- 
take for  a  testicle!    He  then  found  and  removed 


•Reprinted  from  Amencan  Journal  of  VtUrinary  Medicint,  May,  lill. 


88  SPRINGTIME  SURGERY 

the  other  testicle.  The  horse  was  now  very  weak 
and  ate  but  little,  his  sheath  was  a  tremendous 
size,  like  a  sack  of  potatoes. 

Mr.  C.  E.  Smith,  M.  R.  C.  V.  S.,  saw  the  horse 
in  my  stead.  He  found  the  sheath  almost  justi- 
fied the  description  given  it  by  the  owner  of  the 
horse.  It  was  engorged  and  pointing  in  places 
with  infiltrated  urine.  After  casting  the  animal 
and  well  lubricating  the  inside  of  the  sheath  with 
vaseline,  he  discovered,  after  a  lot  of  tedious  manip- 
ulation, the  mutilated  end  of  the  penis  about  a 
foot  away  from  the  natural  opening  of  the  sheath. 
The  swelling  being  so  severe,  the  urine  could  only 
come  away  in  a  small  dribble,  so  he  decided  to 
make  an  opening  for  the  penis  stump  to  come 
through  the  sheath  in  a  position  close  to  the 
proper  castration  wounds.  The  urethra  pro- 
truded about  one-eighth  inch,  but  it  was  impossi- 
ble to  get  a  skin  attachment  for  it;  so  it  was  left 
as  it  was  with  the  intention  of  completing  this 
part  of  the  operation  later  on  when  the  swelling 
had  subsided.  Punctures  were  made  in  various 
parts  of  the  sheath  to  allow  the  urine  which  had 
infiltrated  into  the  surrounding  tissues  to  drain 


A  CASTRATOR'S  ERROR  89 

away.  All  the  parts  were  thoroughly  cleansed 
with  warm  antiseptics  and  dressed  with  carbo- 
lized  vaseline. 

I  saw  the  case  myself  ten  days  afterwards. 
The  sheath  was  slightly  swollen;  horse  eating 
and  improving  in  condition.  Standing  behind 
him  and  pulling  the  tail  aside  I  could  see  about 
four  inches  of  penis  hanging  through  a  wound 
in  the  sheath,  and  in  position  just  where  a  mare's 
teats  would  be.  The  penis  pointed  downwards 
and  backwards,  and  when  urination  took  place 
there  was  a  stream  about  the  calibre  of  a  clinical 
thermometer  case  directed  upon  the  points  of  the 
hocks.  The  urethral  opening  was  clearly  dimin- 
ished in  lumen,  and  I  told  the  owner  that  the 
horse  should  be  cast  again,  and  a  further  small 
portion  of  the  penis  removed  so  that  the  urethra 
could  be  properly  everted  and  stitched  back  to 
avoid  further  stricture.  This  he  would  not  con- 
sent to,  preferring  to  "wait  and  see"  how  the 
horse  went  on. 

I  was  not  asked  to  attend  the  horse  again,  but 
being  in  the  locality  a  month  or  two  afterwards 
saw  him  at  grass.     Both  hocks  were  then  in  a 


90  SPRINGTIME  SURGERY 

terrible  mess,  due  to  the  constant  dribbling  of 
urine  upon  them.  The  urethral  opening  was  evi- 
dently very  small,  as  one  could  see  the  urine  com- 
ing away  from  the  penis  in  a  very  fine  spray. 
Owner  still  refused  surgical  interference.  I 
wrote  him  about  twelve  months  ago  on  another 
matter,  and  asked  him  how  "Farmer"  was  going 
on,  expecting  to  hear  he  had  been  sent  to  the 
kennels.  His  reply  was,  "The  horse  is  working 
on  the  farm  regularly,  and  except  for  requiring 
an  occasional  drench  does  all  right." 

I  might  add  that  I  tried  at  the  time  to  per- 
suade the  owner  to  institute  proceedings  against 
the  castrator,  either  for  cruelty  or  in  a  civil  court, 
but  this  he  would  not  do,  the  reason  being,  as  I 
learned  afterwards,  that  he  had  arranged  terms 
for  the  castrator  to  pay  him  the  sum  of  $125  in 
instalments,  as  damages.  This  would,  of  course, 
account  for  his  desire  to  avoid  further  expense 
or  publicity.  He  wanted  the  matter  kept  quiet 
till  the  money  was  paid;  hence  also  his  employ- 
ing me  in  lieu  of  other  veterinarians  nearer  his 
home. 


Hemorrhage  After 
Castration* 

By  Wirt  R.  Barnard,  D.  V.  S.,  BeHeville,  Kansas 

I  was  called  to  see  a  two-year-old  colt  castrated 
nine  hours  previously  by  a  non-graduate  prac- 
titioner. The  owner  had  stopped  the  hemorrhage, 
but  I  found  the  colt  very  weak  and  staggering, 
pulse  imperceptible,  respiration  abdominal  and 
hurried.  I  administered  one  dram  of  nux  vomica 
and  in  thirty  minutes  noticed  great  improvement. 

The  next  morning,  the  owner  telephoned  the 
colt  was  down,  unable  to  rise,  and  acting  crazy. 
I  made  the  call  and  gave  nine  pints  of  normal 
saline  solution  intraperitoneally.  The  colt  ate 
and  drank  well,  but  after  attempting  to  rise 
showed  cerebral  disturbance.  I  left  a  mixture  of 
nux  vomica,  belladonna,  digitalin  and  ferric 
chloride  to  be  given  in  full  doses  every  two  hours. 


♦Reprinted  from  the  Missouri  Valley   Veterinary  Bulletin,   May,   1908. 


92  SPRINGTIME  SURGERY 

In  addition  to  this  the  colt  was  fed  one-half 
gallon  of  fresh  milk,  one-half  dozen  eggs  and  one- 
fourth  pound  of  sugar,  well-mixed,  twice  daily, 
and  all  the  hay  and  grain  he  wanted.  After  three 
and  one-half  days  he  got  up  on  his  own  accord 
and  has  been  doing  well  ever  since.  I  noticed 
a  decided  change  for  the  better  after  giving  the 
saline  injection  and  had  not  the  distance  from 
my  office  been  so  great  I  would  have  given  a 
second  injection. 

At  another  time  I  was  called  to  see  a  two-year- 
old  mule  that  was  bleeding  badly,  a  result  of 
castration  by  an  empiric.  I  checked  the  hemor- 
rhage externally,  but  the  colt  died  twelve  hours 
later  from  internal  hemorrhage.  I  was  called  to 
this  case  in  the  night  and  the  weather  was  so  dis- 
agreeable and  the  lack  of  conveniences  such,  that 
I  did  not  throw  this  colt  and  secure  and  ligate  the 
artery — ^the  only  proper  procedure.  The  animal 
died  in  spite  of  all  medication  though  I  now  be- 
noticed  it  was  doing  badly.  From  this  on  the  ani- 
lieve  that  full  physiological  doses  of  atropine  hy- 
podermically  would  have  checked  this  as  it  will 
most  other  internal  hemorrhage. 


Castration  of  Pigs  Having 
Scrotal  Hernia 

By  D.  M.  Campbell,  D.  V.  S.,  Chicago 

Cases  of  scrotal  hernia  in  pigs  or  a  rupture 
as  the  farmer  calls  it  is  a  markedly  hereditary 
condition.  On  some  farms  from  year  to  year 
there  are  numerous  cases  of  this  kind  among  the 
pigs;  on  other  farms  this  condition  is  scarcely 
known,  its  presence  or  absence  depending,  as  may 
easily  be  demonstrated,  upon  heredity. 

Some  farmers  castrate  these  pigs  as  readily  as 
they  castrate  their  ordinary  boar  pigs,  but  a  great 
many  others  find  the  operation  difficult  or  are  en- 
tirely unable  to  perform  it  and  with  them  such 
pigs  are  usually  destroyed  as  soon  as  the  hernia 
is  noted  or  the  condition  is  allowed  to  grow  worse 
until  death  results  from  strangulation  of  the  in- 
testine or  from  a  traumatism  to  the  scrotum. 


94  SPRINGTIME  SURGERY 

The  value  of  the  animal  is  so  slight  that 
unless  there  is  a  considerable  number  of  these 
"ruptured"  pigs  in  the  same  brood  or  there  be  a 
very  large  number  of  hogs  raised  upon  the  place, 
this  work  can  never  amount  to  much  from  the 
veterinarian's  point  of  view,  but  frequently  when 
he  is  called  to  a  farm  for  other  work  he  is  asked 
to  castrate  one  or  two  or  three  of  these  pigs. 

There  is  scarcely  an  operation  that  is  more 
simple  than  this  one  and  yet  it  is  one  with  which 
some  veterinarians  have  experienced  a  great 
deal  of  difficulty,  because  of  faulty  technic.  To 
throw  the  animal,  hold  him  on  his  side  and  at- 
tempt to  castrate  him,  as  is  done  in  ordinary  cas- 
tration is  to  bring  on  such  forcible  extrusion  of 
the  intestines  that  no  operator  can  successfully 
accomplish  the  castration,  but  if  the  pig  be  held 
up  by  his  hind  legs  with  his  back  to  the  holder 
and  with  his  forefeet  just  touching  the  ground 
and  possibly  his  neck  between  the  ankles  of  the 
man  holding  him  the  intestines  will  of  their  own 
accord,  or  can  readily  be  made  to,  return  to  the 
abdominal  cavity  and  while  held  in  this  position 
castration   is   an   exceedingly   simple  operation. 


SCROTAL  HERNIA  95 

Observe  the  usual  aseptic  precautions  advisable  in 
all  minor  surgery.  If  the  inguinal  aperture  in 
the  abdominal  wall  is  very  large  it  may  be  neces- 
sary to  hold  the  testicle  through  the  scrotum  while 
the  intestines  are  manipulated  to  prevent  its  re- 
turn into  the  abdominal  cavity  along  with  the 
intestines,  in  which  case  the  animal  would  have  to 
be  lowered  before  the  testicle  would  again  return 
to  the  scrotum,  thus  causing  annoyance  and  repe- 
tition of  the  manipulation  of  the  intestines. 

Holding  the  testicle  between  the  thumb  and 
fingers  as  for  ordinary  castration  cut  through  the 
skin  and  dartos  as  for  the  covered  operation. 
Strip  the  cellular  tissue  from  the  tunica  vaginalis 
as  close  up  to  the  internal  inguinal  ring  as  it  is 
possible  to  get.  Then  place  a  ligature  very  tightly 
around  the  tunica  vaginalis  or  sac  including  the 
cord,  vas  deferens,  the  arteries,  veins  and  nerves, 
first  making  certain  no  portion  of  the  intestine  is 
included  in  the  ligature  and  that  it  is  close  enough 
to  the  internal  inguinal  ring  to  prevent  subse- 
quent saculation  and  a  further  escape  of  the  in- 
testine from  the  abdominal  cavity.  The  ligation 
may  be  made  with  any  stout  cord,  that  has  been 


96  SPRINGTIME  SUSGERY 

rendered  aseptic  and  the  ends  of  it  should  be  left 
long  enough  to  hang  slightly  out  of  the  scrotal 
wound.  Cut  off  the  cord  with  its  covering  mem- 
brane just  back  of  the  ligation.  It  is  a  serious 
mistake  to  incise  the  tunica  vaginalis  before  the 
cord  is  ligated.  Remove  the  other  testicle  and 
the  operation  is  complete. 

The  peritoneal  surfaces  of  the  tunica  vagi- 
nalis will  adhere  in  a  few  hours  and  in  two  or 
three  days  the  portion  of  the  tunic  below  the 
ligation  will  slough  off  and  come  away  together 
with  the  string  with  which  it  is  tied.  It  is  neces- 
sary to  make  the  wound  rather  low  so  that  drain- 
age may  be  free.  The  entire  operation  requires 
less  than  one-half  the  time  it  takes  to  describe  it 
and  the  mortality  is  practically  nil. 

It  may  be  beneath  the  dignity  of  some  veteri- 
narians to  charge  a  fee  for  this  operation  but  the 
operation  is  not  too  insignificant  to  be  appre- 
ciated by  the  owner  and  it  is  well  worth  while 
viewed  from  any  angle.  If  undertaken  at  all 
of  course  it  should  be  well  done. 


Operation  on 
a  Hermaphrodite* 

By  0.  D.  Chedester,  D.  V.  S.,  Cordell,  Oklahoma 

Hermaphrodism  is  a  condition  in  which  there 
is  a  combination  in  a  single  individual  of  both 
male  and  female  generative  organs.  In  some 
cases,  the  individual  possesses  only  one  set  of  in- 
ternal genitals,  but  both  male  and  female  exter- 
nal genitals.  In  others  the  internal  genitals  of 
both  sexes  are  present.  The  former  class  is  the 
more  common  and  to  it  the  case  described  below 
probably  belonged.  Hermaphrodites  which  simu- 
late the  male  more  nearly  than  the  female  are  of 
much  more  frequent  occurrence  than  are  those 
which  most  nearly  resemble  the  female. 

A  client  of  mine  possessed  a  small,  four-year- 
old,  bay,  hermaphrodite  horse,  weighing  less  than 
900  pounds.     The  head,  neck  and  shoulders  of 


♦Reprinted   from   the  American   Journal   of    Veterinary   Medicine, 
March.  1912. 


98  SPRINGTIME  SUKGERY 

this  animal  resembled  a  stallion.  The  posterior 
half  of  the  body  with  its  perfect  udder,  resembled 
a  mare.  Its  disposition  was  that  of  a  stallion. 
The  short  penis,  about  three  inches  long,  in  an 
almost  continuous  state  of  erection,  extended 
through  a  small  opening  six  inches  below  the 
anus.  Through  this  penis  the  urine  was  passed, 
usually  dropping  on  the  tail,  legs  and  buggy 
wheels  though  it  sometimes  reached  the  dash- 
board, making  it  disgusting  as  well  as  embarrass- 
ing to  drive  the  animal. 

The  faults  of  this  critter  were  many.  It  could 
not  be  safely  turned  out  with  other  horses  or 
even  into  a  pasture  adjoining  one  in  which  other 
horses  were  kept.  It  could  not  be  worked  with 
other  horses  with  any  satisfaction.  Every  equine 
looked  to  it  like  a  mare  in  estrum.  With  half  an 
opportunity  it  would  mount  as  for  copulation 
and  with  the  aid  of  its  tail  pressed  against  the 
erected  penis  would  discharge  the  semen  in  its 
own  tail.  This  young  animal,  though  quite  a 
curiosity,  was  worthless  for  practical  purposes. 
The  case,  however,  offered  a  fine  opportunity  for 


A  HERMAPHRODITE  OPERATION  99 

some  experimental  operating  on  my  part,  and  as 
the  owner  agreed  to  it,  the  experiment  was  made. 

This  animal  was  cast  and  chloroformed;  the 
tail  bandaged  and  the  operative  field  cleansed. 
A  sterile  soft  catheter  was  introduced  and  the 
bladder  and  the  urethra  irrigated  with  an  anti- 
septic solution.  The  penis  was  dissected  one 
and  one-half  inches  inward  and  upward  and  ampu- 
tated, leaving  the  urethra  protruding  one-fourth 
of  an  inch.  The  catheter  was  left  in  situ  and  the 
bladder  and  urethra  irrigated  daily  with  a  five 
per  cent  potassium  permanganate  solution  for  one 
week.    The  wound  was  given  a  daily  dry  dressing. 

Owing  to  the  position  and  irregular  size  of  the 
urethra  the  amputation  was  much  more  difficult 
than  this  operation  is  ordinarily.  Two  weeks 
later  a  second  operation  was  performed  by  lay- 
ing open  the  urethra  for  a  distance  of  three 
inches,  thus  for  urinary  purposes  replacing  a 
vulva.  The  wound  was  packed  and  the  edges  al- 
lowed to  heal  without  uniting.  From  this  open- 
ing the  urine  is  now  expelled  as  expeditiously 
as  it  is  from  the  urethra  of  a  mare. 


100  SPRINGTIME  SURGERY 

The  patient  was  given  the  following  treatment : 
Nucleinic  acid  (yeast)  grs.  xii 

Sodium  chloride  grs.  vi 

Sodium  bicarbonate  grs.  v 

Phenol  m.  ii 

Aqua  destillata  oz.  i 

Mix,  filter  and  give  hypodermically  one  dram 
twice  daily  in  an  equal  quantity  of  normal  saline 
solution.  In  one  week  the  animal  was  well  and 
ready  for  work  and  medication  was  discontinued. 
As  the  testicles,  if  developed,  were  in  the  ab- 
dominal cavity,  their  removal  was  planned  for  a 
third  operation,  but  never  attempted  because  not 
necessitated  by  the  changed  disposition  of  the  ani- 
mal which  strangely  enough  from  the  first  opera- 
tion became  docile  and  began  to  grow  and  fatten 
until  now  it  weighs  more  than  1,300  pounds.  It 
can  be  turned  loose  or  worked  with  other  horses 
with  satisfaction,  and  is  a  beast  of  burden  equal 
to  a  mule.  How  are  we  to  explain  the  loss  of 
sexual  desire  without  the  removal  of  either  testi- 
cles or  ovaries? 


Spaying  Heifers  on  Western 
Ranches* 

By  A.  W.  Whitehouse,  D.  V.  S.,  Boulder,  Colorado 

Calls  for  this  work  on  the  part  of  the  cow- 
men are  not  at  all  regular,  and  depend  on  three 
factors:  the  demand  for  breeding  she-stock,  the 
price  at  market  points  on  fat  open-cows  and 
heifers,  and  the  amount  of  available  grazing. 
Perhaps  the  most  important  of  these  is  the  price 
of  fat  open-cows.  When,  as  at  present,  these  sell 
within  a  dollar  or  a  dollar  and  a  quarter  of  steers 
of  similar  breeding,  very  little  spaying  will  be 
done.  There  is  now  no  discrimination  at  mar- 
ket points  against  spayed  heifers  as  such,  and 
they  sell  on  their  merits  at  a  price  fully  equal  to 
steers  in  similar  condition.  This  is  as  it  should 
be,  for  they  certainly  dress  out  as  well  as  steers, 
and  sometimes  better. 


♦Reprinted    from    the    American    Journal    of    Veterinary    Medicine, 
April,  1911. 


102  SPRINGTIME  SURGERY 

One  big  outfit  for  which  I  have  worked,  from 
an  annual  brand  of  about  2,000  calves  of  both 
sexes,  "cuts"  the  poorer  half  of  the  heifers  for 
spaying  each  year,  and  this  bunch,  though  it  con- 
tains all  the  odd  colors  and  ill-shapen  calves,  is 
said  to  make  them  more  money  than  the  open 
heifers  or  the  steers.  Spayed  heifers  are  quieter 
than  steers,  and  though  they  will  not  quite  come 
to  the  same  weight,  they  will  ripen  more  quickly, 
and  on  very  much  less  feed. 

In  discussing  spaying  with  an  owner  who  is 
contemplating  it  for  the  first  time,  it  is  well  to 
advise  him  to  be  prepared  to  carry  the  heifers 
over  at  least  two  seasons,  as  it  requires  that 
length  of  time  for  the  complete  unsexing  of  the 
carcass  and  to  derive  the  full  benefit  of  the 
operation. 

While  the  median-line  operation  is  easier  and 
quicker,  and  the  immediate  loss,  providing  the 
stitching  is  quite  perfect,  should  be  no  greater, 
yet  there  are  good  reasons  for  preferring  the 
flank  operation.  One  of  my  clients  has  had  a 
good  opportunity  to  compare  their  merits,  and  I 


SPAYING  HEIFERS  103 

have  been  able  to  confirm  his  observations.  Hav- 
ing 400  flank-spayed  yearlings  of  his  own  breed- 
ing, he  purchased  800  median-line  spayed  year- 
lings from  a  neighbor,  the  operations  having  been 
performed  within  six  weeks  of  each  other. 
Among  the  flank  spayed  yearlings  were  a  very 
few  rather  persistent  stitch  abscesses  (in  a 
harmless  place)  which  eventually  disappeared. 
Among  those  operated  upon  through  the  median 
line  there  were  a  number  of  hernial  sacs,  and 
more  having  a  (supposedly  peritoneal)  fistula 
which  discharged  a  fluid  usually  clear.  These 
did  not  fatten,  and  some  few  died,  a  year  to 
eighteen  months  later. 
This  is  my  technic  for  the  flank  operation: 
Preparation. —  Just  preceding  the  spaying, 
thirty-six  hours  of  starvation  is  desirable  but  not 
often  obtainable  on  the  range  from  lack  of  suit- 
able corrals.  The  animals  should  be  watered  the 
night  before  the  operation  or  they  get  too 
"proddy." 

Restraint.—  I  have  never  tried  the  chute  and 
should  suppose  it  slow.  It  is  desirable  to  jam  a 
lot  of  them  in  a  small  corral  for  roping  and 


104  SPRINGTIME  SURGERY 

"shake"  them  out  into  a  big  corral  of  at  least 
an  acre  for  the  operation.  If  the  operating 
corral  is  small  the  spayed  heifers  are  always 
charging  the  operator.  We  usually  rope  them 
by  the  head  and  the  hind  feet  and  stretch  them. 
The  upper  or  left-forefoot  goes  into  the  neck 
noose  and  a  figure  of  eight  is  put  on  just  above 
the  hind  fetlocks.  The  adjustment  of  this  re- 
quires a  good  man  on  the  tail.  It  is  best  to 
have  a  man  sit  on  the  head  with  the  forefoot 
pulled  over  with  a  handle  noose.  It  is  hard, 
however,  to  get  the  boys  to  do  this  as  they 
prefer  to  stretch  them  between  two  horses.  This 
brings  the  abdomen  too  tight,  and  after  breaking 
through  it  is  often  necessary  to  ask  the  man  on 
the  hind  rope  to  slacken,  so  that  occasionally  the 
heifers  kick  loose  from  the  figure  eight  knot. 

Field  of  Operation. —  Have  the  left  side 
uppermost  in  the  recumbent  position;  stand  at 
the  loin  and  rump  and  not  at  the  abdomen.  Grasp 
all  of  the  flank  you  can  get  into  the  left  hand  and 
tense  the  skin.  About  two  inches  from  the  heel 
of  the  hand  begin  the  incision  and  cut  straight 
towards  you — make  it  plenty  long  enough  for 
easy  work. 


SPAYING  HEIFERS  105 

I  never  clip  or  shave  the  hair  from  the  field  of 
operation,  considering  that  there  isn't  time  to  do 
a  good  job  and  I  am  more  likely  to  introduce 
clipped  hair  than  loose  hair,  though  I  often  find  a 
little  of  the  latter  in  my  hand.  I  swab  the  field 
very  freely  with  a  two  per  cent  solution  of  zeno- 
leum  or  some  of  the  coal-tar  disinfectants. 

The  incision  will  be  very  little  if  any  forward 
of  the  point  of  the  ilium  and  will  be  surprisingly 
low  down  when  they  get  up.  Here  the  external 
oblique  muscle  is  aponeurotic.  I  make  an  in- 
cision parallel  with  the  fibres  about  one  inch  long 
and  enlarge  with  the  index  finger  of  each  hand. 
I  then  force  my  right  hand  cone-shaped  into  the 
incision  and  as  soon  as  I  feel  the  peritoneum, 
jerk  in  my  hand  so  as  not  to  separate  it  from 
the  wall. 

Equipment. —  I  wear  blue  overalls  and  a 
jumper,  a  clean  suit  each  morning;  have  my  shirt 
sleeves  rolled  up  but  the  jumper  sleeves  hanging 
loose  for  a  protection  from  the  sun. 

For  the  skin  and  aponeurotic  incision  I  buy 
old  razors  and  carry  four  with  me.  The  blade  is 
ground  away  so  that  there  is  only  about  one  inch 


106  SPRINGTIME  SURGERY 

of  it  left  at  the  end  and  a  cutting  edge  put  on  the 
heel.  I  have  a  scalpel  in  my  pocket  but  seldom 
use  it.  The  other  instrument  is  a  pair  of  curved 
serrated  shears  six  and  one-fourth  inches  long 
such  as  some  use  for  spaying  bitches.  I  have  a 
pair  of  long  spaying  shears  (serrated)  and  a 
spaying  emasculator  but  never  use  them. 

At  the  fence  I  have  several  pans,  etc.,  and  the 
instruments  go  into  a  five-percent  carbolic  acid 
solution  when  not  in  use.  One  pocket  of  my  jump- 
ers I  keep  soaked  in  five  percent  carbolic  acid  and 
carry  the  instruments  in  it.  I  wash  as  often  as 
possible  in  surgeon's  boric-acid  soap  and  water, 
but  I  cannot  stand  antiseptics  in  it  for  more  than 
half  a  day's  work. 

Removal  of  Ovaries. — After  breaking  in,  as 
described,  I  turn  the  fingers  toward  the  pelvis 
keeping  the  peritoneal  wall  in  touch  and  with  the 
back  of  the  hand  push  back  a  fold  of  intentine. 
The  left  ovary  should  lie  close  at  hand.  I  grasp  it 
and  bring  it  to  the  surface  and  with  an  instru- 
ment, razor,  scalpel,  or  scissors  shred  the  broad 
ligament  till  the  ovary  lies  passive,  but  attached, 
in  the  left  hand.    Possibly  dipping  the  right  arm 


SPAYING  HEIFERS  107 

in  the  swab  bucket  I  reintroduce  it  and  follow  the 
broad  ligament  to  get  the  right  ovary.  Sometimes 
the  tension  has  brought  this  within  two  inches  of 
the  surface  and  sometimes  it  is  very  hard  to  find 
(the  weak  point  of  the  recumbent  operation).  I 
break  down  the  broad  ligament  by  passing  the 
fingers  through  it  and  gradually  bring  it  to  the 
surface.  This  breaking  through  the  broad  liga- 
ment is  very  wearing  on  the  skin  of  the  fingers, 
soaked  as  it  is,  and  the  ligament  cuts  nearly  to  the 
bone  on  the  first  and  fourth  fingers  near  the  distal 
joint.  If  the  ligament  is  tough  it  needs  shredding 
with  the  scalpel  held  in  the  left  hand ;  it  is  rather 
risky  to  transfer  the  ovary  to  the  left  as  it  snaps 
back  if  the  heifer  struggles.  Most  of  them,  how- 
ever, come  out  on  a  shred.  I  never  introduce  an 
instrument  into  the  cavity,  feeling  that  in  rough, 
hasty,  routine  work  there  is  danger  in  so  doing. 
Finally  I  shred  the  ovaries  off,  using  an  instru- 
ment if  necessary. 

Sutures. — One  in  the  aponeurosis  of  the  ex- 
ternal oblique  and  two  in  the  skin — all  three  in- 
terrupted. I  use  common  string  cut  in  suitable 
lengths,  soaking  it  all  day  in  a  strong  coal  tar 


108  SPRINGTIME  SURGERY 

dip,  ten  percent  solution.  An  assistant  does  this 
work.  He  dips  his  hands  frequently  in  an  anti- 
septic solution.  Most  of  the  heifers  go  to  market, 
but  one  of  my  clients  has  butchered  a  few  and  he 
tells  me  that  there  is  an  adhesion  of  skin  and 
deeper  structures  at  the  operative  wound,  but 
that  the  string  has  disappeared.  When  every- 
thing is  going  smoothly  the  operator  works  a 
little  faster  than  the  stitcher. 

Steel  sacking  needles,  five  inches  long  are  best 
but  the  six-inch  needle  will  do.  Have  a  mechanic 
take  the  temper  out,  and  give  them  a  slight  curve 
in  the  pointed  one-third,  with  the  curved  part 
flattened  and  a  cutting  edge  on  each  side  and  then 
re-tempered.  Good  steel  needles  are  hard  to  get, 
the  common  ones  will  not  do.  The  edge  should  be 
kept  sharp  enough  to  cut  the  suture  string  when 
the  stitches  are  complete.  This  is  the  only  good 
design  for  a  needle.  Such  a  one  will  go  through 
the  gastrocnemius  tendon  or  plantar  cushion  with- 
out hard  pressure  and  without  a  jerk. 

After  Treatment.—  I  dress  liberally  with  pire 
tar  thickened  with  flour  according  to  the  weather 
and  let  them  drift  on  to  good  pasture  direct  from 


SPAYING  HEIFERS  109 

the  corral;  if  they  have  to  be  moved  it  must  be 
by  good  cowmen  and  very  carefully.  Confinement 
in  a  lot,  or  corral,  I  have  never  tried  and  should 
not  care  to. 

Failures. —  In  about  one  percent  I  fail  to  get 
the  deep  ovary  in  a  reasonable  time  and  let 
them  up. 

I  never  spay  pregnant  heifers,  stopping  at 
once  even  if  I  have  removed  the  left  ovary  before 
being  aware  of  the  condition. 

Mortality. —  When  the  last  bunch  I  spayed 
was  nearly  finished  the  boys  broke  the  leg  of  one 
in  throwing  her,  but  I  think  they  were  getting 
tired  of  bacon.  In  each  of  two  lots  that  I  spayed, 
one  heifer  was  found  dead  about  six  weeks  later, 
tion.  This  has  been  the  total  loss  among  up- 
wards of  1100  heifers  spayed  during  1910  and 
1911.  I  am  not  a  quick  operator,  about  125 
heifers  a  day  being  my  limit,  and  the  antiseptics, 
peritoneal  fluid  and  sun  are  very  hard  on  my  skin. 
If  my  results  have  been  good  I  attribute  it  to  two 
things:  first,  reasonable  cleanliness,  and  second, 
never  using  an  instrument  except  on  structures  in 
plain  view. 


110  SPRINGTIME  SURGERY 

Prospective.  —Spaying  heifers  is  becoming  more 
and  more  popular  on  the  ranges  as  the  price  of 
good  beef  increases  over  that  of  poorer  grades. 
And  resident  veterinarians  are  doing  a  larger  and 
larger  percentage  of  this  work  which  was  for- 
merly done  almost  exclusively  by  itinerant  "special- 
ists." No  veterinarian  locating  in  this  region 
can  afford  to  neglect  spaying. 


Oophorectomy  in  Cats* 

By  G.  E.  Corwin,  Jr.,  D.  V.  S.,  Canaan,  Conn. 

In  performing  feline  oophorectomy  and  to  in- 
sure a  successful  termination,  the  operation 
should  differ  materially  from  that  usually  per- 
formed upon  bitches. 

If  the  median-line  operation  is  followed  with 
cats,  they  will  invariably  remove,  or  at  least  dis- 
turb, the  stitches  and  always  give  more  or  less 
trouble  if  not  actually  bringing  on  a  fatal  termi- 
nation by  this  means.  Upon  cats  the  following 
technic  for  the  operation  will  give  best  results : 

Place  the  animal  upon  a  slanted  table,  sus- 
pended by  the  hind  legs  and  with  the  head  low- 
ered. Shave  and  disinfect  the  skin  for  the  flank 
operation,  either  side,  and  when  properly  pre- 
pared anesthetize  with  ether. 

In  making  the  incision,  first  make  it  through 
the  skin  only,  at  a  point  anterior  or  posterior  to 


♦Reprinted   from   th«   American   Journal  of   Veterinary  Medieine, 
December,  1911. 


112  SPRINGTIME  SURGERY 

the  incision  to  be  made  in  the  muscle  and  perito- 
neum, then  draw  the  skin  incision  to  the  point  to 
be  incised  in  the  muscle. 

Pick  up,  with  the  sterile,  little  finger,  the  fallo- 
pian tubes,  which  can  readily  be  located  without 
the  use  of  the  probe. 

Draw  the  ovaries  into  the  incision  and  remove. 
Return  the  tubes.  Suture  the  muscles  and  peri- 
toneum with  the  same  interrupted,  sterilized, 
catgut  sutures,  (two  probably  being  enough) 
wipe  dry  with  sterile  absorbent  cotton,  and  allow 
the  skin  incision  to  return  to  its  proper  position, 
which  will  cause  the  incision  in  the  muscle  to  be 
entirely  covered. 

Do  not  put  any  suture  in  the  skin  incision,  and 
the  cat  will  do  no  other  harm  to  it  than  licking. 
If  sutures  are  used  in  the  skin  the  cat  will  try  to 
and  usually  does  remove  them.  This  is  the  pri- 
mary cause  of  the  median-line  incision  being  so 
troublesome. 

Do  not  use  any  carbolic  preparation  for  disin- 
fecting instruments  to  be  used  on  a  cat,  nor  use 
any  such  preparation  for  disinfecting  the  skin  of 
these  animals.    I  prefer  chinosol. 


Prolapsus  Uteri :  Its  Successful 
Treatment* 

By  A.  J.  Treman,  D.  V.  M.,  Lake  City,  la. 

On  the  morning  of  May  17,  1909,  the  phone 
wakened  me  uncomfortably  early.  Answering  it, 
I  learned  that  a  farmer  eight  miles  away  wanted 
me  to  come,  in  a  hurry,  to  his  place.  His  answers 
to  a  few  questions  revealed  that  he  had  a  msxe 
with  an  eversion  of  the  uterus.  I  directed  him  to 
get  a  large  dishpan,  fill  it  with  clean  hot  water 
and  place  the  everted  ma^s  into  it  and  keep  pour- 
ing hot  water  over  it  continually  until  I  arrived. 

When  I  arrived,  I  found  a  fine  large  five-year- 
old  mare,  with  a  complete  eversion  of  the  uterus 
and  vagina.  The  pulse  was  weak  and  rapid,  res- 
pirations hurried  and  distressed,  the  animal 
suffering  considerable  pain  and  quite  weak;  how- 
ever the  owner  had  carefully  followed  my  instruc- 
tions, and  all  hemorrhage  was  stopped,  there  was 


"Reprinted  from  American  Journal  Veterinary  Medicine,  Dec.,  191L 


114  SPRINGTIME  SURGERY 

only  moderate  swelling  of  the  mass,  all  the  parts 
were  reasonably  clean  and  pliable  and  ready  to 
be  replaced.  I  immediately  administered  hypo- 
dermic stimulants  and  a  small  dose  of  aromatic 
spirits  of  ammonia,  then  proceeded  to  put  myself 
in  readiness  to  replace  the  organ.  By  the  time 
this  was  done,  I  found  that  the  patient  was  show- 
ing some  effect  from  the  stimulant. 

With  some  difficulty  we  succeeded  in  getting  the 
animal  upon  her  feet,  after  which  it  was  com- 
paratively easy  to  replace  the  organ.  With  the 
return  of  the  uterus,  I  inserted  my  hand  and  arm, 
as  the  Dutchman  said,  "Yust  so  far  as  I  had  any," 
and  did  what  I  could  to  restore  all  the  parts  to 
their  natural  position,  meanwhile  resisting  the 
animal's  straining.  While  my  hand  was  still  in 
the  uterus,  I  had  an  assistant  pump  in  a  pail  full 
of  clean,  hot,  weak,  disinfectant  solution,  this  dis- 
tended the  uterus  and  horns  to  such  an  extent 
that  I  was  able  to  restore  all  the  parts  to  their 
normal  position  before  the  animal  strained 
enough  to  throw  out  any  of  the  solution.  Then 
I  siphoned  off  the  liquid,  injected  more  and  si- 
phoned it  off,  and  kept  on  repeating  this  until 


PROLAPSUS  UTERI  115 

the  liquid  was  returned  clean  and  there  was  a 
contraction  of  the  uterus  to  such  an  extent  that 
on  withdrawing  the  hand  I  was  able  to  siphon  off 
practically  all  of  the  liquid.  After  this  there  was 
very  little  straining,  and  though  I  placed  a  truss 
in  position  it  was  not  really  necessary. 

For  several  hours  we  had  to  be  very  faithful 
with  our  stimulants,  and  left  generous  doses  of 
quinine,  iron  and  strychnine  to  be  given.  On  the 
second  and  third  days  following,  we  thoroughly 
flushed  the  uterus.  This  animal  made  a  com- 
plete and  uneventful  recovery.  I  have  had  other 
cases  that  seemed  hopeless  make  a  nice  recovery 
under  this  plan  of  treatment,  two  points  of  which 
I  wish  to  emphasize. 

First.  Endeavoring  to  get  the  owner  to  thor- 
oughly irrigate  the  prolapsed  mass  until  I  get  to  it. 

Second.  Filling  the  returned  uterus  with  a  hot, 
weak,  disinfectant  solution,  to  help  in  restoring 
all  parts  to  their  normal  positions,  and  the  re- 
peated injections  and  siphoning  of  the  solution 
until  there  is  a  strong  contraction  of  the  organ. 
This  I  find  valuable  in  all  cases  where  flushing  is 
necessary. 


Unusual  Case  of  Obstetrics* 

By  Dr.  H.  Jensen,  Kansas  City,  Missouri 

A  gentleman  called  at  my  office  stating  that 
one  of  his  valuable  brood  mares  was  having  labor 
pains  though  she  was  not  due  to  foal  for  a  couple 
of  months.  A  few  doses  of  viburnum  was  pre- 
scribed and  I  heard  nothing  more  about  the 
matter. 

About  two  months  later  I  was  called  to  his 
place  and  informed  that  in  the  forenoon  this 
mare  had  given  birth  to  a  dead  colt  but  kept  on 
straining.  On  examination  I  found  lodged  in  the 
OS  a  scapula,  and  in  the  uterus  I  found  the  com- 
plete skeleton  of  another  foal.  All  the  soft  struc- 
tures were  gone,  the  bones  all  disarticulated  but 
no  decomposition.  The  uterus  had  contracted 
considerably  by  this  time,  and  a  number  of  bones 
were  firmly  imbedded  in  the  folds  of  the  uterus, 
the  womb  was  flushed  a  few  times  with  antisep- 
tic astringents  and  recovery  of  the  mare  followed. 


♦Reprinted  from  the  Missouri  Valley  Veterinary  Bulletin,  August,  1909. 


Proper  Replacement  of 
the  Everted  Uterus* 

By  Sam  Meader,  D.  V^  S.,  Goff,  Kansas 

Eversion  of  the  uterus  is  a  very  common  occur- 
rence in  cows.  Presumably  the  reason  for  the 
greater  frequence  of  this  condition  in  cows  than 
in  other  animals  is  on  account  of  the  closer  union 
in  this  animal  between  the  placenta  and  the  uterus. 
The  peculiar  arrangement  in  the  cow  by  which 
the  fetal  coverings  are  in  effect  buttoned  over  the 
maternal  cotyledons  renders  the  separation  of  the 
afterbirth  difficult  and  often  attended  by  eversion 
of  the  uterus. 

It  is  not  the  cleansing  and  replacing  of  the 
everted  uterus,  difficult  though  the  operations  are, 
that  give  the  veterinarian  the  most  trouble.  It  is 
keeping  the  uterus  in  place  during  the  subsequent 
twelve  to  seventy-two  hours  that  taxes  his  pa- 


*Reprinted  from  the  Missouri  Valley  Veterinary  Bulletin,   August, 
1909. 


118  SPRINGTIME  SURGERY 

tience,  ability  and  ingenuity.  Anodynes,  sutur- 
ing the  vulva,  the  use  of  pessaries,  surcingles,  ele- 
vating the  rear  of  the  cow,  all  have  their  incon- 
veniences and  drawbacks  and  at  times  all  fail. 

We  know  in  human  kind  what  discomfort  and 
pain  and  even  alarming  constitutional  symptoms 
may  result  from  even  a  comparatively  slight  dis- 
placement of  the  uterus.  Having  this  in  mind,  it 
occurred  to  me  that  possibly  the  straining  and 
consequent  eversion  of  the  uterus  in  the  cow  may 
be  due  to  the  traction  upon  and  resulting  dis- 
placement of  the  uterus  by  a  too  closely  adherent 
placenta.  And  that  the  straining  following  the 
replacement  of  the  organ  was  due  to  a  failure  on 
the  part  of  the  operator  to  get  it  into  the  normal 
position. 

I  have  recently  been  trying  the  long-continued 
effect  of  gravity  on  the  uterus  filled  with  water 
and  in  the  limited  number  of  cases  in  which  I  had 
the  opportunity  to  try  it  I  have  been  pleased  with 
the  results.    The  following  case  will  illustrate: 

A  cow  that  had  everted  her  uterus  after  giving 
birth  to  a  living  calf.  I  found  the  animal  in  an 
old  peach  orchard  that  was  grown  up  with  under- 


EVERTED  UTERUS:  REPLACEMENT    119 

brush.  She  had  been  walking  about  considerably 
and  the  uterus  was  very  much  lacerated,  swollen 
and  bleeding  and  thoroughly  covered  with  feces 
and  other  dirt.  It  was  a  case  where  the  indica- 
tions were  for  continued  straining.  I  cleaned  up 
this  uterus  carefully  in  a  warm  three  percent 
CreoHn  solution  and  with  considerable  difficulty 
replaced  it  after  standing  the  cow  in  the  stall  with 
her  hind  feet  about  a  foot  higher  than  the  front 
ones.  She  at  once  began  to  strain  violently.  With 
my  arm  inserted  and  with  the  aid  of  an  assistant 
I  commenced  running  in  a  weak  solution  of 
potassium  permanganate  and  continued  this  for 
two  hours,  when  her  straining  had  nearly  ceased. 
I  instructed  the  owner  to  continue  the  irrigation 
for  two  hours  longer.  No  other  treatment  was 
given.  The  following  evening  and  the  next  morn- 
ing the  owner  reported  the  cow  doing  fine.  She 
did  not  strain  any  more  and  a  week  later  she  had 
fully  recovered,  all  discharges  having  stopped. 


Pervious  Urachus* 

By  C.  L.  Wilhite,  D.  V.  S.  Manilla,  la. 

During  the  latter  part  of  the  period  of  ges- 
tation the  urine  passes  from  the  fetus  through  a 
canal  or  tube  into  the  allantoid  cavity  (a  space 
between  the  outer  and  inner  folds  of  the  placenta, 
the  chorion  and  amnion,  and  lined  with  the  mid- 
dle fold  of  the  allantois) .  This  canal  is  called  the 
urachus.  When  parturition  begins  this  urine  con- 
tained in  the  allantoid  cavity  is  a  part  of  the  fluid 
that  passes  when  the  placental  envelopes  break. 

Some  authorities  claim  that  pervious  urachus 
is  caused  by  a  stricture  of  the  urethra,  but  I  have 
found  such  to  be  the  cause  in  only  a  few  of  many 
cases  that  I  have  met.  I  believe  it  is  caused  by 
some  freak  of  nature  or  a  disease  which  prevents 
closure  of  the  urachus  at  the  bladder  at  birth  or 
soon  afterwards. 


♦Reprinted    from    the    American    Journal    of    Veterinary    Medicine, 
December,  1911. 


PERVIOUS  URACHUS  121 

In  cases  of  pervious  or  persistent  urachus  the 
urine  passes  from  the  umbilicus  in  a  stream  or  by 
drops  during  the  act  of  urination  and  in  occa- 
sional cases  drips  continuously.  The  hair  around 
the  umbilicus  is  generally  wet.  As  the  affliction 
gets  older  there  is  a  catarrhal  discharge  and  later 
pus.  Occasionally,  perhaps  often,  there  is  an  in- 
fection present  which  if  unmolested,  works  up 
the  umbilical  vein  to  the  portal  vein,  then  quickly 
to  the  liver,  next  the  joints  swell  and  the  battle 
for  life  is  on. 

In  1907  I  treated  nine  cases  of  pervious 
urachus  which  later  developed  septic  arthritis. 
I  used  ligatures,  cautery,  injections,  and,  as  the 
disease  developed,  several  pounds  of  echinacea 
and  other  drugs  too  numerous  to  mention.  Eight 
died  of  the  nine  and  one  lived  but  remained  an 
unthrifty  dwarf.  I  had  about  the  same  success, 
or  rather  failure,  with  my  cases  in  1908  and  1909. 

In  the  spring  of  1910  a  veterinarian  recom- 
mended pure  oil  of  turpentine  to  me  as  a  cure 
for  Sweeney  and  gave  me  a  bottle  to  try.  After 
seeing  the  swelling  it  caused  I  decided  to  try  it 
on  a  case  of  pervious  urachus  to  close  the  opening. 


122  SPRINGTIME  SURGERY 

I  did  so,  and  the  leaking  stopped  in  a  few  hours. 
Since  then  I  have  been  using  it  continuously  and 
have  had  only  a  few  fatalities. 

The  treatment  is  as  follows:  Cast  the  patient 
without  ropes  so  it  may  be  let  up  quickly  when 
through.  Clip  the  hair  around  the  umbilicus  and 
wash  with  soap  and  water.  Rub  dry  with  a  clean 
cloth.  Cleanse  the  urachus  with  peroxide  in  a 
syringe  with  a  long,  small  nozzle  clear  into  the 
bladder.  Wash  the  foam  out  with  pure  water. 
Get  a  few  drops  of  pure  oil  of  turpentine  in  the 
syringe,  insert  nozzle  into  the  urachus  to  within 
an  inch  and  a  half  of  the  bladder,  as  near  as  can 
be  guessed.  Inject  turpentine  slowly  drawing  the 
syringe  out  at  the  same  time  then  let  the  patient 
up  quickly.  Inform  the  owner  that  the  patient  will 
do  some  scratching  for  a  while,  and  that  if  the 
navel  is  leaking  in  three  or  four  days  the  treat- 
ment will  have  to  be  repeated.  Generally  one 
treatment  will  suffice.  Occasionally  it  takes  two 
or  three. 

Females  are  more  easily  cured  than  males.  If 
all  the  urine  passes  from  the  urachus  there  is  a 
stricture  of  the  urethra  and  it  should  be  cathe- 
terized  if  possible. 


Care  of  Navels  in  Newborn* 

By  W.  L.  Williams,  V.  S.,  author  of  "Veterinary  Obstetrics," 
"Surgical  and  Obstetric  Operations,"  etc.,  Professor  of 
Surgery  in  the  New  York  State  Veterinary  College, 
Cornell  University,  Ithaca,  New  York 

The  care  of  the  navel  of  the  new-born  domes- 
tic animal  has  been  the  subject  of  much  differ- 
ence of  opinion  amongst  veterinarians  and  lay- 
men and  has  been  greatly  influenced  by  compari- 
son with  the  theories  and  practices  of  human 
obstetrics. 

In  general  we  accept  as  a  truism  in  practice 
that  a  given  course  of  action  is  alike  applicable 
in  all  mammalia  and  hence  that  the  correct 
method  of  dealing  with  the  navel  of  a  child  will 
apply  to  all  mammals.  There  are  however  some 
very  important  differences  among  mammals  which 
serve  to  test  the  applicability  in  practice  of  this 


♦Reprinted   from   the   American  Journal   of   Veterinary   Medicine, 

April,    1911. 


124  SPRINGTIME  SURGERY 

generally  accepted  theory.  The  navel  cord  of  the 
foal  and  the  calf  are  much  more  ample  compara- 
tively than  that  of  the  child  or  of  the  young  of  car- 
nivora.  The  environment  in  which  young  are 
born  differs  widely,  and  the  care  bestowed  upon 
the  navel  cord  by  the  mother  also  varies  greatly. 
The  attitude  of  the  young  animal  further  changes 
conditions  materially. 

In  herbivora  the  navel  cord  is  normally  rup- 
tured by  linear  tension.  It  generally  parts  at  a 
particularly  frail  point  near  the  umbilicus.  The 
cord  being  tensely  stretched  at  the  moment  of 
parting,  the  umbilic  arteries  are  much  elongated 
and  when  they  finally  break,  the  proximate  ends 
recoil,  retracting  into  the  abdominal  cavity,  draw- 
ing with  them  in  an  inverted  state  the  surround- 
ing loose  perivascular  tissue.  The  ruptured 
arterial  stump  is  thus  promptly  withdrawn  from 
the  exterior  where  it  might  become  infected,  and 
the  inverted,  adherent  connective  tissue  at  once 
aids  the  contracting  arterial  stump  in  controlling 
the  hemorrhage.  The  umbilic  vein,  or  veins,  col- 
lapse. The  stump  of  the  urachus  retracts  within 
the  abdominal  cavity  between  the  two  arterial 


CARE  OF  NAVELS  IN  NEWBORN  125 

stumps.  Thus  the  vessels  are  promptly  out  of 
harm's  way.  The  mother  next  gives  the  navel  im- 
portant attention  by  licking.  This  act  is  gener- 
ally supposed  to  be  purely  cleansing  but  it  is  very 
much  more.  When  intact,  the  naval  cord  is 
largely  made  up  of  the  gelatinous,  semi-fluid 
Whartonian  gelatin  which  if  left  in  the  cord 
affords  an  excellent  breeding  ground  for  patho- 
genic microorganisms.  This  fluid,  under  normal 
conditions,  slowly  oozes  from  the  stump  of  the 
cord  and  the  latter  finally  desiccates,  but  the 
mother  greatly  hastens  this  process  by  a  kind  of 
tongue-massage.  The  fluid  is  forcibly  pressed  out 
during  the  licking  process.  This  is  especially  em- 
phasized in  the  cow  with  her  rough,  prehensile 
tongue,  with  which  she  exerts  much  force.  In 
harmony  with  this,  calves  suffer  far  less  from 
navel  infection  than  do  foals,  whose  navels  get 
less  tongue  massage  from  the  mother.  In  fact 
naval  infection  in  calves  is  seen  mostly  in  those 
early  removed  from  their  dams  and  this  natural 
care  of  the  navel  by  the  mother  prevented. 

Ligation    Harmful.  —  Many  veterinarians  and 
most  veterinary  obstetricians  advise  or  practise 


126  SPRINGTIME  SURGERY 

the  ligation  of  the  navel  cord  of  the  new-born. 
They  do  not  generally  state  their  reasons  there- 
for. It  was  advised  by  Nocard  for  the  preven- 
tion of  "white  scours"  in  calves,  though  just  why 
it  should  prevent  this  dreaded  disease  is  not  clear. 
It  certainly  can  not  prevent  the  entrance  of  in- 
fection through  the  navel.  We  may  limit  infec- 
tion to  some  extent  by  a  ligature  around  a  living 
tissue,  as  when  we  ligate  a  hernial  sac,  but  even 
there  our  power  is  vague.  In  that  case  however 
we  apply  the  ligature  to  living,  active  tissues, 
cutting  off  nutrition  on  one  side  of  the  ligature 
and  leaving  it  comparatively  undisturbed  on  the 
other  side,  where  a  protective  wall  against  any 
threatening  infection  is  quickly  established.  In 
the  navel  cord  it  is  quite  otherwise.  The  interrup- 
tion of  the  placental  circulation  and  establish- 
ment of  the  pulmonary  functions  renders  the  um- 
bilic  stump  a  dead  mass  of  tissue.  The  arterial 
stumps  and  the  urachus  have  retracted  and  are 
no  longer  in  the  cord,  while  the  vein  or  veins  have 
wholly  ceased  to  function  and  are  dead.  The  re- 
maining umbilic  tissues,  the  amniotic  sheath  of 
the  cord,  the  areolar  tissue  and  Wharton's  jelly 


CARE  OF  NAVELS  IN  NEWBORN  127 

included  within  it  are  dead  and  all  that  now  re- 
mains of  the  navel  stump  must  ooze  away,  desic- 
cate or  decay.  It  must  be  clear  to  anyone  that  a 
ligature  applied  around  a  columnar  mass  of  dead 
tissues  can  not  prevent  the  invasion  of  bacteria 
on  either  side  of  the  ligature;  it  can  not  hold 
either  the  distal  or  proximal  tissue  against  bac- 
terial invasion. 

Fortunately  for  the  calf  the  navel  cord  usually 
ruptures  before  the  birth  act  has  been  completed 
and  the  arterial  and  urachal  stumps  have  re- 
tracted within  the  abdomen  out  of  reach  of  the 
meddler.  In  the  foal  the  navel  cord  is  longer  and 
a  ligature  may  be  applied  before  it  is  ruptured 
and  the  arteries  and  urachus  become  incarcerated 
and  their  infection  rendered  probable. 

The  most  serious  objection  to  ligation  lies  in 
the  fact  that  the  ligature  imprisons  within  the 
amniotic  sheath  all  of  Wharton's  jelly  and  all  blood 
which  may  ooze  from  the  withdrawn  arterial 
stumps  if  they  have  retracted.  If  the  arteries 
have  not  retracted  and  are  caught  in  the  ligature 
a  large  blood  clot  is  imprisoned  just  above  the 
ligature;  any  urine  oozing  from  the  retracted 


128  SPRINGTIME  SURGERY 

urachus  is  also  imprisoned,  and  any  blood  re- 
maining in  the  umbilic  vein  or  veins  is  likewise 
retained.  This  retention  of  liquids  within  the 
dead  tissues  serves  to  invite  infection  and  is  in 
direct  conflict  with  surgical  principles,  one  of  the 
most  fundamental  rules  of  which  is  the  ample  pro- 
vision of  free  drainage  for  all  inactive  useless  fluids. 

Sources  of  Infection. — The  ligation  of  the 
navels  of  new  born  domestic  animals  is  rarely 
carried  out  under  aseptic  or  antiseptic  precau- 
tions of  even  a  crude  character;  usually  the 
hands  of  the  ligator,  and  the  ligature  are  bear- 
ers of  infection.  After  meeting  this  danger  the 
foal  or  calf  spends  much  of  its  time  with  the  navel 
stump  in  contact  with  dung  or  other  filth.  When 
standing  the  moist  navel  stump  is  a  favorite  feed- 
ing place  for  flies,  bearing  various  infections. 

But  it  is  held,  the  human  obstetrician  ligates 
the  navel  stump  and  why  should  not  we  also? 
The  cases  are  not  parallel.  The  human  obstetri- 
cian ligates  the  cord  under  careful  antisepsis, 
after  expressing  the  jelly  of  Wharton  and  other 
fluids,  then  applies  antiseptic  or  aseptic  dress- 
ings to  the  wound  which  is  retained  in  place  by  a 


CARE  OF  NAVELS  IN  NEWBORN  129 

clean  bandage  and  the  infant  is  kept  ir  a  dorsal 
recumbency  with  no  opportunity  for  fecal,  urinal 
or  other  soiling  of  the  dead  stump. 

Navel  Hemorrhage  Not  Serious. —  If  the  liga- 
tion of  the  navel  cannot  prevent  infection  there 
would  seem  to  be  but  two  other  reasons  for  the 
procedure,  hemostasis  and  fashion.  In  an  exten- 
sive obstetric  practice  extending  over  thirty-two 
years  the  writer  has  not  observed  fatal  or  impor- 
tant naval  hemorrhage  and  has  learned  of  but 
one  case  from  his  fellow  veterinarians.  That  one 
case  was  in  a  foal,  belonging  to  a  veterinarian 
who  ligated  the  cord.  Apparently  he  had  excised 
the  cord  too  long,  the  excised  arterial  stumps  re- 
tracted up  through  the  ligature  and  failed  to 
close  as  the  ruptured  end  would  have  done,  the 
escaping  blood  accumulated  above  the  ligature, 
distending  the  amniotic  sheath  of  the  cord,  pushed 
it  off  and  permitted  the  fatal  hemorrhage. 

Fatal  umbilic  hemorrhage  rarely,  if  ever,  fol- 
lows the  normal  division  of  the  umbilic  cord  by 
linear  tension  (herbivora)  or  by  gnawing  (carniv- 
ora).  Ligation  is  wholly  superfluous  from  a 
hemostatic  standpoint  and  if  accompanied  by  ex- 


130  SPRINGTIME  SURGERY 

cision  of  the  cord  adds  greatly  to  the  danger  from 
hemorrhage  because  an  excised  artery  bleeds 
more  freely  than  an  artery  severed  by  any  other 
method.  Clinically  an  artery  is  generally  not 
held  by  a  ligature  about  the  cord,  especially  if  the 
cord  is  divided  reasonably  short.  As  that  is  the 
case  in  most  navel  ligations  the  control  of  the 
hemorrhage  is  due,  not  to  the  ligation  but  to  auto- 
hemostasis,  in  the  ordinary  course  of  the  normal 
physiologic  powers  of  the  umbilic  arteries. 

If  we  examine  the  question  clinically  we  find 
that  the  above  conclusions  are  borne  out  by  every- 
day experience. 

Prevention  of  Infection.—  Foal  after  foal 
perishes  from  navel  infection  and  a  far  larger 
percentage  of  foals  succumb  with,  than  without, 
ligation.  On  the  other  hand,  navel  infection  is 
uniformly  prevented  by  open  antiseptic,  desiccant 
handling  of  the  navel  If  the  normally  ruptured 
navel,  or  the  navel  artificially  divided  in  a  man- 
ner simulating  the  natural  method  (linear  ten- 
sion, scraping,  ecrasement)  under  antiseptic  pre- 
cautions— ^the  jelly  of  Wharton  pressed  out  and 
a  desiccant  antiseptic  applied  navel  infection  is 


CARE  OF  NAVELS  IN  NEWBORN  131 

promptly  and  effectively  barred.  If  the  freshly 
ruptured  navel,  from  which  the  Wharton's  jelly 
and  other  fluids  have  been  expressed,  is  immersed 
in  a  1-1000  corrosive  sublimate  solution  for  fifteen 
to  twenty  minutes  it  will  have  become  well  dis- 
infected. This  may  be  conveniently  accomplished 
by  filling  a  cup  with  a  solution  and  pressing  it 
against  the  abdominal  floor  around  the  navel, 
thus  immersing  the  navel  stump  within  the  solu- 
tion. After  this  thorough  disinfection,  desicca- 
tion of  the  stump  may  be  hastened  and  the  sealing 
of  the  wound  against  infection  insured  by  dust- 
ing the  stump  over  with  a  powder  consisting  of 
equal  parts  of  gum  camphor,  alum  and  starch, 
finely  powdered.  This  may  be  repeated  every 
thirty  minutes  until  the  desiccation  is  complete 
and  a  hard,  dry  antiseptic  scab  is  the  sole  rem- 
nant of  the  umbilic  stump;  the  wound  is  sealed 
and  infection  is  excluded. 

If  sure  that  the  navel  is  reasonably  clean,  the  im- 
mersion of  the  stump  in  the  corrosive  sublimate 
solution  may  be  safely  omitted  and  the  desiccating 
antiseptic  powder  at  once  applied.  Or  after  the 
cord  has  been  ruptured  and  the  fluids  expressed 


132  SPRINGTIME  SURGERY 

from  the  stump  it  may  be  efficiently  disinfected 
and  desiccated  by  the  application  of  tincture  of 
iodine,  but  this  needs  be  done  with  great  care, 
lest  the  skin  about  the  navel  be  blistered.  Iodine 
is  not  wholly  safe  in  the  hands  of  the  layman,  and 
it  is  the  layman  who  must  usually  care  for  the 
navel  of  the  new-born  under  directions  from  the 
veterinarian. 

While  we  frequently  see  glowing  accounts  of 
how  navel  infection  in  new-born  animals  has  been 
cured  by  this  or  that  veterinarian  by  bacterins  or 
other  very  remarkable  remedies,  the  conservative 
veterinarian  would  as  yet  prefer  secure  prophy- 
laxis to  glorious,  sensational  cures.  He  may  not 
get  as  much  money  out  of  it,  but  he  will  gain 
much  in  satisfaction  and  in  professional  standing. 


Superfetation  With  Report 
of  a  Case* 

By  R.  F.  Bourne,  B.  Sc. ,  D.  V.  S. ,  Professor  o*  Physiology, 
Kaosas  City  Veterinary  College 

By  the  term  superfetation  is  meant  conception 
in  an  animal  already  pregnant  before  the  termi- 
nation of  the  primary  period  of  gestation.  This 
term  should  not  be  confused  with  superfecunda- 
tion — the  fertilization  of  two  or  more  ova  of  the 
same  ovulation  by  separate  copulative  acts. 

Opportunity  for  erroneous  conclusions  in  cases 
of  this  character  is  so  great  that  some  authori- 
ties have  doubted  the  possibility  of  its  occur- 
rence; but  there  are  recorded,  several  indisputa- 
ble cases  of  superfetation  and  doubtless  some  who 
read  this  may  recall  occurrences  in  their  own  ex- 
perience.    However,  these  instances  seem  to  be 


•Reprinted  from  the  Missouri  Valley  Veterinary  Bulletin,  July,  1909. 


134  SPRINGTIME  SURGERY 

exceedingly  rare;  far  rarer  than  cases  where 
double  conception  has  resulted  from  connection 
with  two  different  males  at  intervals  separated 
only  by  a  few  hours.  Fleming  records  cases 
where  women  have  borne  twins,  one  white  and 
one  mulatto,  from  copulation  with  a  white  man 
following  that  with  a  negro  or  vice  versa,  and 
similar  cases  where  a  horse  and  a  mule  colt  were 
delivered  at  one  birth  when  service  with  a  horse 
and  a  jack  was  had  on  the  same  day.  These  are 
cases  of  superfecundation. 

The  more  remarkable  instances  are  those  in 
which  conception  has  occurred  from  two  copula- 
tive acts,  weeks  or  months  apart  (superfetation), 
and  where  each  fetus  is  carried  for  the  full  period 
of  gestation.  One  of  these  cases  occurred  in  New 
York  in  1876.  A  five-year-old  mare  bore  a  fully- 
developed,  well-formed  dead  colt  on  February 
twenty  and  on  the  second  of  April  another  sound, 
healthy  fully-developed  live  colt.  Other  cases  in 
which  two  fetuses  in  different  stages  of  develop- 
ment have  been  delivered  at  one  birth  are  more 
frequent.  The  following  case  of  this  kind  re- 
cently came  under  my  observation. 


SUPERFETATION  135 

I  was  called  by  a  farmer  who  reported  that 
he  had  a  mare  which  had  foaled  and  which  was 
not  behaving  properly.  Upon  my  arrival  about 
nine  p.  m.,  I  found  a  black,  twelve-year-old  mare 
exhibiting  symptoms  of  mild  colic  and  treated 
her  accordingly.  Vaginal  exploration  revealed 
conditions  normally  present  after  parturition. 
The  owner  then  related  the  following  history: 
The  mare  had  been  purchased  by  him  five  months 
before,  and  was  said  to  be  in  foal  from  a  horse 
or  jack,  she  having  been  bred  to  both.  She  had 
been  served  first  by  the  jack,  and  in  order  to  in- 
sure conception  was  returned,  some  three  weeks 
later,  to  the  town  where  the  jack  was  kept.  In 
the  meantime,  however,  the  jack  had  been  re- 
moved and  the  owner  allowed  the  mare  to  be 
served  by  a  percheron  stallion.  So  far  as  the 
present  owner  knows  no  subsequent  service  was 
had  and  the  opportunities  for  it  seem  very  re- 
mote, judging  from  the  conditions  under  which 
most  farm  mares  are  kept. 

A  few  hours  prior  to  my  call  the  mare  gave 
uneventful  birth  to  two  colts,  one  an  immature 
mule  and  shortly  after  a  well-formed  full-term 


136  SPRINGTIME  SURGERY 

horse  colt.  Both  were  dead.  The  mule's  body 
was  not  yet  completely  covered  with  hair  and  its 
size  was  not  more  than  one-third  that  of  the 
full-term  foal. 

The  only  explanation  I  can  offer  as  to  the  im- 
mature state  of  this  foal  was  that  it  had  been 
carried  dead  for  some  months  and  had  resisted 
decomposition  and  mummification  until  normal 
conditions  had  delivered  it  along  with  the  horse 
colt.  The  carrying  of  a  dead  fetus  for  this 
length  of  time  is  not  rare  and  unless  service  was 
had  with  a  jack  at  a  later  period  than  that  with 
the  stallion,  we  must  accept  some  such  explana- 
tion. Parturition  occurred  about  two  weeks  be- 
fore the  normal  period  of  gestation,  for  the 
horse  colt,  had  expired. 


Atresia  Ani* 


By  A.  T.  Kinsley,  M.  Sc,  D.  V.  S.,  Pathologist,  Kansas  City 
Veterinary  College,  Author  of  "Veterinary  Pathology"  etc. 

During  the  embryonic  stage  of  intrauterine 
life  the  specialized  tissues  and  organs  are  formed. 
The  fetal  period  is  the  time  during  which  the 
structures  formed  in  the  embryonic  stage  grow 
and  develop.  At  birth  the  young  of  a  given 
species  are  of  a  definite  shape,  contour  and  type; 
the  form  or  type  which  is  most  common  is  ac- 
cepted as  normal;  and  deviations  from  the  nor- 
mal are  designated  malformations,  anomalies  or 
developmental  errors.  Many  new  strains  and 
breeds  of  live  stock  have  been  the  result  of  de- 
velopmental errors  becoming  a  fixed  peculiarity. 
Thus  the  polled  cattle,  the  Boston  bull-dog,  the 
Mexican  (hairless)  dog,  and  the  five-toed  chicken 
had  their  origin. 

A  variety  of  malformations  are  of  course 
seen  at  the  season  when  veterinarians  are  called 


^Reprinted  from  the  AftMOurt  Valley  Veterinary  Bulletin,  June.  1908. 


138  SPRINGTIME  SURGERY 

to  attend  cases  of  parturition.  Obstetrical  cases 
in  addition  to  the  general  practice  entails  the  ex- 
penditure of  considerable  energy  and  the  prac- 
titioner may  not  be  as  careful  and  observing  in 
some  cases  as  he  should  be. 

Atresia  Ani  is  a  malformation  that  is  not  rare 
and  is  frequently  not  observed  by  the  attending 
obstetrician.  This  malformation  is  the  result  of 
imperfect  union  of  tissues.  During  the  earlier 
stages  of  development,  i.  e.,  the  embryonic  period, 
the  digestive  tract  from  the  pharynx  to  the  rec- 
tum inclusive  is  formed  from  the  entodermal 
tube.  The  anus  is  formed  in  the  fetal  stage  by 
invagination  of  the  skin  surface,  the  anus  and 
rectum  are  at  this  stage  separated  by  a  thin 
membrane.  Normally  the  rectal  and  anal  walls 
fuse,  the  separating  membrane  is  absorbed  and 
thus  there  is  produced  a  continuous  canal. 

Failure  of  the  anal  invagination,  failure  of 
fusion  of  the  anal  and  rectal  walls,  or  failure  of 
solution  of  the  separating  membrane  would  re- 
sult in  an  imperforation  and  there  would  be  no 
outlet  for  the  escape  of  the  contents  of  the  diges- 
tive tube. 


ATRESIA  ANI  139 

The  communication  between  the  bladder  and 
intestine  may  persist  thus  allowing  the  fecal  mat- 
ter to  discharge  into  the  bladder.  A  communica- 
tion may  also  occur  between  the  intestine  and 
urethra  or  the  intestine  and  vagina. 

The  young  of  any  domestic  animal  could  not 
survive  long  without  evacuation  of  the  contents 
of  the  digestive  tube.  Atresia  ani  occurs  most 
frequently  in  pigs  and  calves,  though  colts  and 
other  animals  are  not  exempt.  This  malforma- 
tion is  usually  easily  relieved  by  an  operation  the 
nature  of  which  depends  upon  the  specific  con- 
dition existing.  If  there  has  been  failure  of  ab- 
sorption of  the  separating  membrane  it  may  be 
ruptured  by  the  use  of  a  blunt  instrument  no 
further  treatment  being  necessary.  In  those 
cases  resulting  from  the  failure  of  fusion  of  the 
rectal  and  anal  walls,  the  intervening  tissue 
should  be  very  carefully  dissected  and  the  walls 
of  the  rectum  and  anus  approximated  and 
sutured.  When  there  has  been  a  failure  of  cuta- 
neous invagination  a  crucial  incision  should  be 
made  through  the  skin  and  the  intervening  tissues 
bluntly  dissected  to  the  lumen  of  the  rectum,  then 


140  SPRINGTIME  SURGERY 

the  mucous  membrane  of  the  rectum  should  be 
pulled  outward,  sutured  to  the  skin  or  margins  of 
the  opening  made  by  the  dissection  so  that  the 
mucous  membrane  and  skin  are  continuous  and 
form  a  lining  for  the  artificial  opening. 

If  there  is  a  communication  between  the  intes- 
tine and  the  bladder  urethra,  or  vagina  it  should 
be  closed  by  a  plastic  operation  and  the  external 
opening  made  as  indicated  above. 


Treatment  of  Contracted 
Tendons  in  Foals' 

By  James  Smellie,  M.  D.  C,  Eureka,  Illinois 

The  title  of  this  paper  should  really  be  "Treat- 
ment of  Contracted  Tendons  and  Ligaments  in 
Young  Colts,"  because  in  the  majority  of  cases 
the  ligaments  are  just  as  much  at  fault  as  are  the 
tendons.  The  contraction  of  one  or  both  of  these 
structures  is  a  ccndition  that  the  country  prac- 
titioner meets  very  often,  and  in  most  cases,  it  is 
quite  serious. 

Every  year  we  see  a  number  of  colts  born  with 
such  marked  contraction  of  the  flexor  tendons  and 
posterior  ligaments  of  the  forelegs  that  the  ani- 
mal knuckles  over  on  the  fetlock  joint,  and  is  un- 
able to  extend  the  phalanges.  The  condition,  if 
allowed  to  continue  very  long,  causes  an  undue 


•Reprinted  from  the  Missouri  Valley  Veterinary  Bulletin,  Feb.,  1910. 


142  SPRING-TIME  SURGERY 

extension  of  the  extensor  pedis  tendon,  and  also 
of  the  anterior  part  of  the  capsular  ligament. 
This,  combined  with  the  bruising  of  the  skin,  from 
contact  with  the  ground  sets  up  a  thickening  over 
the  joint  that  is  apt  to  remain. 

In  some  colts  the  flexure  is  at  the  carpus.  In 
such  cases  the  metacarpal  muscles  and  check  liga- 
ments are  most  affected;  in  some  cases  delivery- 
is  effected  with  the  front  legs  flexed.  I  have  seen 
a  few  cases  of  this  condition  in  the  hind  legs,  with 
the  contractions  at  the  fetlock  and  the  flexor  ten- 
dons most  affected. 

Etiology. —  This  malformation  is  caused,  I  be- 
lieve, by  the  limbs  becoming  flexed  in  utero  and 
for  some  inexplicable  reason,  remaining  that  way 
too  long.  It  may  possibly  be  hereditary  in  some 
cases,  when  one  or  both  parents  have  upright 
shoulders  and  short  straight  pasterns.  I  know 
of  a  mare  of  such  conformation  that  has  had  two 
colts  in  succession,  sired  by  the  same  horse,  that 
knuckled  completely  over  on  one  front  fetlock, 
and  could  touch  the  ground  with  only  the  toe  of 
the  other  leg.  Her  colts  were  sound  when  sired 
by  another  horse. 


CONTRACTED   TENDONS   IN    FOALS         143 

Treatment.—  Only  in  those  cases  where  the 
colt  was  lively  and  energetic  have  I  ever  been 
successful  in  my  treatment  of  them.  When  the 
animal  is  young  the  ligaments  and  tendons  will 
stretch  a  long  way  if  the  limbs  can  be  brought 
into  position  so  the  animal  can  use  them. 

In  the  hind  leg,  it  is  comparatively  easy,  pro- 
vided the  flexors  are  not  too  short.  I  make  a  bar 
shoe  exactly  the  size  of  the  foot  with  a  projection 
coming  straight  forward  about  three  inches,  then 
turning  it  up  to  form  a  brace  to  which  the  limb  is 
strapped.  The  fetlock  joint  forms  an  admirable 
fulcrum  for  the  brace,  and  every  time  the  ani- 
mal stands  up  it  stretches  the  tendon,  which  soon 
allows  the  foot  to  assume  its  natural  position.  If 
there  is  too  much  contraction  section  of  the  per- 
f orans  has  to  be  performed. 

In  the  front  leg,  treatment  is  more  difficult,  be- 
cause all  joints  flex  in  one  direction.  I  make  a 
bar  shoe  exactly  the  size  of  the  foot  with  a  forked 
projection  in  front  extending  from  two  to  four 
inches.  If  the  joint  is  weak  and  inclined  to  break 
over  outward,  it  may  be  necessary  to  weld  on  a 
spur  on  the  outside  of  the  shoe.    It  is  necessary 


144  SPRINGTIME  SURGERY 

to  raise  the  points  of  those  projections  and  give 
the  foot  a  rolhng  motion  backwards.  The  feet 
are  very  soft  for  a  few  days,  but  generally  about 
the  third  or  fourth  day,  the  hoof  is  hard  enough 
to  hold  the  nails. 

In  a  few  cases  where  the  joints  were  weak,  I 
have  had  to  put  on  a  plaster  cast  for  a  few  days 
to  stiffen  the  joints  enough  so  the  animal  could 
get  in  the  habit  of  using  its  feet. 

When  the  carpus  is  affected,  tenotomy  of  the 
metacarpi  medius  and  the  perforans  tendons  has 
to  be  performed. 


Minor  Means  of  Restraint 

By  D.  M.  Campbell,  D.  V.  S.,  Chicago 

The  veterinarian  and  particularly  the  young 
veterinarian  who  can  control  his  patient  with  the 
least  expenditure  of  time  and  energy  on  his  own 
part  as  well  as  with  the  greatest  measure  of 
safety  to  himself  and  to  the  animal  is  in  a  fair 
way  not  only  to  do  better  surgery  because  of 
this  perfect  control  but  to  win  favor  with  his 
clients  and  a  reputation  for  "horse  sense'*  which 
is  so  necessary  to  one  who  would  be  considered 
by  stockmen  a  master  in  his  profession. 

On  the  other  hand  the  inability  to  cast,  throw 
or  tie  an  animal  as  well  as  the  owner  himself  can, 
is  one  of  the  greatest  handicaps  a  veterinarian 
can  have,  not  only  because  of  the  actual  incon- 
venience to  which  he  is  subjected  but  also  be- 
cause of  the  lessened  respect — ^the  almost  con- 
tempt the  owner  will  have  for  a  veterinarian  on 
this  account  alone.    A  veterinarian's  clients  ex- 


146  SPRINGTIME  SURGERY 

pect  him  to  know  more  about  their  animals  than 
they  themselves  do  and  regard  with  suspicion  the 
knowledge  of  a  veterinarian  who  knows  less 
than  they  about  controlling  animals. 

An  ever-present  example  of  the  above  may  be 
seen  in  the  regard  most  horsemen  have  for  the 
incompetent  veterinary  dentist  who,  though  he 
knows  very  little  about  a  horse's  teeth  and  their 
abnormalities,  from  long  practice  is  able  to  handle 
the  horse  while  dressing  the  teeth  in  a  very  skill- 
ful manner,  and  to  float  the  teeth  quickly,  without 
the  use  of  a  speculum  and  with  almost  no  resist- 
ance from  the  patient.  Contrast  the  effect  of 
such  "smooth  work"  with  the  bunglesome  method 
of  some  competent  though  unpracticed  veter- 
inarian who  has  done  little  of  this  work  and 
whose  final  results  when  the  work  is  completed 
are  infinitely  better  than  the  other,  and  one  may 
see  at  once  how  much  horsemen  appreciate 
"horse  sense" — "handiness." 

Nothing  else  is  quite  equal  to  ingenuity  and 
of  course  common  sense  in  handling  animals. 
To  some  extent  every  case  presents  its  own  prob- 
lem; but  a  few  suggestions  that  are  capable  of 


MINOR  MEANS  OF  RESTRAINT  147 

modification  to  apply  to  a  large  variety  of  cir- 
cumstances may  be  useful,  particularly  to  the 
recent  graduate  in  veterinary  medicine  whose 
boyhood  and  early  manhood  was  not  spent  on  a 
farm  or  among  animals. 

To  Handle  the  Hind  Feet  of  an  Unbroken 
Horse*. — Take  a  piece  of  five-eighths  inch  rope 
with  a  noose  at  one  end  that  will  not  slip  and 
large  enough  to  go  around  the  neck  near  the 
shoulder,  then  put  a  half -hitch  around  the  body, 
just  back  of  where  the  backhand  of  a  harness 
comes,  then  take  on  back  through  a  strap  buckled 
firmly  around  the  root  of  the  tail.  To  this  fix  a 
ring  or  a  knot  and  connect  a  small  block-and- 
tackle  with  it  and  to  a  hobble  on  the  foot  to  be 
raised.    A  ten-year-old  boy  can  do  the  rest. 

To  Pass  the  Knisely  Stomach  Tube* — Draw 
very  tightly  around  the  nose  a  common  hame 
strap,  this  is  placed  just  high  enough  so  as  not 
to  interfere  with  the  animaFs  breathing.  Then 
lubricate  the  tube  and  pass  it  in  through  the  in- 
terdental space  and  down  the  esophagus  as  usual. 


♦By  H.  B.  Treman,  D.   V.  M.,  Rockwell  City,   Iowa;  reprinted  froii 

the  Missouri  Valley  Veterinary  Btdletin,  July,  1909. 


148  SPRINGTIME  SURGERY 

The  animal  breathes  much  easier  than  it  does 
when  a  mouth  speculum  is  used  and  consequenlly 
does  not  resist  the  operation  so  strenuously.  Be- 
sides, the  little  strap  is  far  more  convenient  to 
carry  than  a  heavy  speculum.  I  also  think  that 
the  tube  is  less  liable  to  enter  the  trachea  when 
so  used  than  it  is  with  the  mouth  held  open. 

Restraint  for  Cattle. — I  have  been  surprised 
to  find  some  veterinarians  unfamiliar  with  the  al- 
most universal  means  or  method  for  throwing  a 
cow,  and  many  others  that  though  familar  with 
this  means  of  throwing  the  animal  have  thought 
that  after  the  animal  is  thrown  it  needs  further 
tying  to  hold  it  down  for  various  operations. 
This  is  not  the  case.  Two  ropes,  one  with  which 
to  tie  the  animal  by  the  head  and  another  single 
rope  twenty-five  feet  long  are  sufficient  for  one 
man  to  throw  and  hold  the  largest  bull  for  an 
operation  for  actinomycosis  or  for  putting  a  ring 
in  his  nose  or  for  almost  any  other  operation 
except  upon  the  feet  and  legs. 

To  cast  and  control  cattle  where  one  has  not 
the  assistance  of  trained  cow  men  and  cow  horses 
or  ponies,  select  a  piece  of  sloping  ground,  the 


MINOR  MEANS  OF  RESTRAINT  149 

steeper  the  slope  the  better  within  reasonable 
limits.  Tie  the  animal  by  the  horns  or  with  a 
halter  at  the  ground  to  a  strong  stake  or  post, 
then  loop  one  end  of  a  strong  rope  around  the  ani- 
mal's neck  near  the  shoulder.  Tie  the  loop  so 
that  it  will  not  slip.  Take  a  "half  hitch"  or  loop 
behind  the  shoulder  and  another  just  in  front  of 
the  anterior  angle  of  the  ilium  and  the  udder  or 
scrotum.  The  first  of  these  "half  hitches"  is  not 
essential  but  the  second  is  very  necessary.  Then 
get  the  animal  to  stand  back  from  the  post  to 
which  it  is  tied  as  far  as  possible  and  pull  steadily 
and  strongly  upon  the  rope,  determining  the  side 
upon  which  you  want  the  animal  to  lie  by  pulling 
at  a  slight  angle. 

If  in  falling  the  animal  should  slacken  the  rope 
by  which  it  is  tied  at  the  head  it  must  be  allowed 
to  rise  and  the  throwing  repeated  and  kept  up 
until  the  animal  falls  with  the  head  rope  taut. 
With  a  very  little  experience  the  operator  will  be 
able  to  accomplish  this  quickly,  usually  at  the  first 
throw,  and  in  no  case  requiring  more  than  two 
attempts. 


150  SPHINGTIME  SURGERY 

After  the  animal  falls  keep  the  rope  tight  and 
it  will  very  soon  cease  to  attempt  to  rise.  Then 
have  an  assistant  take  the  rope  and  pull  strongly 
upon  it  almost  at  a  right-angle  to  the  long  axis  of 
the  animal's  body,  standing  just  a  little  bit  back 
of  where  a  right  angle  line  would  run.  Allow 
the  legs  to  remain  free  and  the  animal  to  use 
them  as  much  as  it  likes.  In  this  way  the  strug- 
gling will  do  no  harm  and  even  cows  heavy  with 
calf  may  be  operated  upon  for  lump  jaw  or  other 
ailments  without  the  slightest  danger  of  produc- 
ing an  abortion  or  otherwise  injuring  them. 

With  the  animal  in  this  condition  an  operation 
upon  the  fore  feet  or  fore  legs  offers  little  diffi- 
culty. Simply  flex  the  legs  strongly  and  tie  them 
there.  The  hind  feet  offer  a  little  more  difficulty, 
particularly  if  it  is  desirable  to  keep  an  animal 
in  an  advanced  stage  of  pregnancy  from  injur- 
ing itself  through  struggling,  but  the  ingenious 
veterinarian  will  have  little  difficulty. 

To    Control   Cattle    in    a  Standing    Position.* 
— For  castrating  old  bulls,  or  for  giving  them 


♦Reprinted  from  the  American  Journal  of  Veterinary  Medicine,  July, 
1911. 


MINOR  MEANS  OF  RESTRAINT  151 

tuberculin  injections,  when  they  evince  a  desire 
to  kick  and  for  many  other  operations  not  upon 
the  head,  cattle  may  be  restrained  without  going 
to  the  trouble  to  cast  them,  by  the  following  very 
simple  expedient: 

Have  the  animal  securely  tied  by  the  head  and 
take  two  strong  poles — fence  rails  serve  admira- 
bly, and  cross  them  beneath  the  animal.  Two 
assistants  should  then  lift  upon  the  rails,  so  that 
the  animal  rests,  just  in  front  of  the  udder  or 
scrotum,  a  part  of  the  weight  upon  the  rails 
crossed  saw-buck  fashion  with  the  long  ends  up. 

To  Break  a  Horse  From  Pulling  Back. — 
One  may  often  curry  much  favor  with  his  clients 
by  showing  them  how  to  break  a  horse  from  pull- 
ing back  upon  the  halter.  This  is  a  very  simple 
matter  and  one  with  which  every  veterinarian 
should  be  familiar. 

Take  any  strong  rope  but  preferably  a  new 
three-eighth-inch  hard  twisted  one  such  as  is  used 
for  lariats  and  make  a  small,  non-slipping  loop 
in  one  end.  Place  the  rope  about  the  horse's  body 
just  posterior  to  the  fore  legs,  run  the  free  end 
of  the  rope  through  this  loop,  take  it  between  the 


152  SPRINGTIME  SURGERY 

forelegs  and  forward  through  the  ring  in  the 
head  stall  of  the  halter.  Tie  to  the  manger  or  a 
post  or  anything  solid,  just  short  enough  so  that 
when  the  animal  backs  as  far  as  this  rope  will 
let  him  he  will  still  lack  about  a  foot  of  taking 
up  the  slack  in  the  halter  rope  and  then  leave 
him  to  his  own  salvation,  or  if  he  should  refuse 
to  pull,  after  a  reasonable  time,  induce  him  to  do 
so  by  "shooing"  him  or  slapping  him  over  the 
head  with  a  sack  or  something  of  that  kind.  It 
is  best,  however,  to  let  him  get  caught  at  his  old 
trick  of  his  own  initiation.  The  tightening  of  the 
rope  about  the  chest  will  frighten  the  animal  very 
much  and  he  will  at  once  spring  forward  and  will 
not  repeat  the  process  until  he  forgets  about  it. 
Three  or  four  experiences  of  this  kind  are  usually 
sufficient  to  break  the  habit  in  the  worst  puller. 


The  Treatment  of  the 
Injured  Hand  * 

How  to  Cleanse  it  and  How  to  Examine  it 

By  Ralph  St.  J.  Perry,  M.  D.,  Santa  Fe,  Isle  of  Pines,  Cuba 

(Editor's  Note. — Minor  injuries  to  the  hands  that  are  infected  dur^ 
ing  their  work  and  become  serious  are  of  such  common  occurrence 
among  veterinarians  that  no  apology  is  required  for  presenting  this 
excellent  article,  a  chapter  from  Dr.  Perry's  book  on  "The  Injured 
Hand,"  here  even  though  it  deals  with  no  phase  of  veterinary  surgery. 
The  principles  here  given  apply  alike  to  minor  surgery  of  both  man  and 
animals.  Dr.  L.  A.  Merillat,  the  most  widely  read  surgeon  among 
veterinarians  has  pronounced  this  article  the  best  "surgery"  that  has 
tver   appeared   in   a   veterinary   publication.} 

Probably  every  accidental  wound  is  an  infected 
wound.  Out  of  several  hundred  of  such  injuries 
only  two  were  found  to  be  noninf ected  when  sub- 
jected to  bacteriologic  tests.  The  infection  usually 
is  coincident  with  the  injury,  and  it  is  doubtful 
whether  any  method  of  wound  cleansing  has  yet 
been  devised  which  will  surely  and  immediately 
eliminate  this  primary  infection. 


♦Reprinted  from  the  American  Journal  of  Veterinary  Medioma,  No- 
vember, 1910. 


154  SPRINGTIME  SURGERY 

The  rapidity  with  which  infection  can  spread 
from  one  portion  of  a  wound  to  another,  or  from 
an  infected  wound  to  adjacent  healthy  tissues,  is 
startling.  Schimmelbusch  inoculated  the  tip  of  a 
mouse's  tail  with  anthrax  germs  and  ten  minutes 
later  cut  off  the  tail  at  its  root ;  the  mouse  died  of 
anthrax.  Reichel  maintains  that  one  minute  after 
inoculation  the  most  thorough  antiseptic  treat- 
ment is  powerless  to  prevent  infection.  What, 
then,  can  be  expected  where  an  injury  is  rarely 
seen  by  the  surgeon  until  fifteen  minutes  after  its 
infliction,  while  oftener  it  is  thirty  minutes  or  an 
hour? 

Observation  and  experiment  have  proved  that 
powerful  antiseptics  devitalize  the  tissues  and  do 
more  harm  than  good.  This  is  particularly  true 
of  carbolic  acid,  cresylic  acid  and  corrosive  sub- 
limate. These  are  cited  because  they  are  the  ones 
most  commonly  used  by  the  profession  and  laity, 
and  the  most  dangerous.  If  it  be  true  that  these 
antiseptics  cannot  prevent  or  counteract  infec- 
tion and  that  they  by  their  destructive  action  upon 
the  tissues  really  tend  to  create  a  field  for  the  de- 
velopment of  germs,  why  use  them  at  all?    The 


TREATMENT  OF  INJURED  HAND  155 

question  is  a  proper  one,  and  my  answer  is,  Don*t! 

Don't  1136  carbolic  acid. 

Don't  use  cresylic  acid! 

Don't  use  corrosive  sublimate! 

But  if  not  these,  what  would  you  use?  It  is 
desirable  to  use  an  antiseptic  which  will  prevent 
further  infection  and  the  further  development  of 
infecting  germs  already  in  the  wound.  We  want 
a  protective  and  preventive  which  is  not  caustic 
or  irritating,  something  that  will  cleanse  without 
doing  injury  and  which  will  guard  against  the 
assaults  of  extraneous  germs. 

Surgical  Cleansing  of  the  Injured  Hand.— 
The  vast  majority  of  injured  hands  are  those  of 
mechanics  and  laboring  men  and  come  to  the  sur- 
geon smeared  with  machine  grease,  paint,  varnish, 
mud,  mortar,  sawdust,  flour,  tobacco  quids,  cob- 
webs, and  many  other  substances  which  are  a  part 
of  honest  labor  or  which  have  been  applied  to  the 
wound  in  well-meant  but  misguided  efforts  to  stop 
bleeding  or  ease  pain.  To  remove  these  substancee 
I  use  three  applications: 

Warm  saline  solution, 

Gasolin,  plain  and  iodized, 

Warm  solution  of  mercuric  cyanide. 


156  SPRINGTIME  SURGERY 

The  saline  solution  (a  teaspoonful  of  clean  table 
salt  to  each  pint  of  boiled  water)  is  familiar  to  all 
and  needs  no  special  mention.  It  is  used  to  re- 
move the  grosser  portions  of  the  dirt — ^the  term 
"dirt"  being  here  employed  as  applying  to  all  mat- 
ter out  of  place. 

Use  Gasolin  to  Remove  Oil  and  Grease.-* 
In  cases  where  the  injured  parts  are  soiled  with 
machine  grease,  paint,  oil,  varnish  and  similar 
substances  not  removable  by  water,  resort  is  had 
to  ordinary  commercial  gasolin.  The  use  of  gaso- 
lin for  this  purpose,  while  not  general,  is  not  a 
novelty.  I  have  so  utilized  it  for  more  than 
twenty-five  years;  others  have  used  it,  and  it  is 
now  quite  generally  used  by  surgeons  who  have 
much  factory,  machine-shop  or  railroad  surgery. 
While  acting  as  a  solvent  for  fats,  oils,  gums,  wax 
and  resins,  it  is,  to  a  certain  extent,  antiseptic,  be- 
sides causing  no  pain;  hence  it  makes  an  excel- 
lent detergent  when  the  parts  are  besmeared  with 
such  substances. 

The  addition  of  resublimed  iodine  to  the  gasolin 
(one  dram  to  the  pint)  increases  its  antiseptic 
powers  without  affecting  its  detergency.    Iodized 


TREATMENT  OF  INJURED  HAND  157 

gasolin  should  be  freshly  prepared,  in  small 
quantities,  at  the  time  of  use. 

To  use  the  gasolin,  pour  it  directly  upon  the 
wound  from  a  small-mouth  bottle,  letting  it 
wash  all  over  portions  of  the  injury;  also  make 
a  mop  of  absorbent  cotton  or  gauze,  saturate  with 
the  gasolin  and  gently  rub  over  the  parts  until 
cleansed.  If  the  dirt  be  unusually  tenacious,  a 
soft  tooth-brush  may  be  used.  The  body-heat 
causes  the  gasolin  to  evaporate  from  the  surface, 
leaving  the  parts  clean  and  dry. 

Gasolin  is  almost  as  efficient  as  hydrogen  per- 
oxide in  breaking  up  adherent  clots,  and  is  not 
painful. 

By  way  of  caution :  The  surgeon  must  remem- 
ber that  gasolin  vapor  is  highly  inflammable,  even 
explosive ;  also,  that  if  it  gets  into  the  eye,  ear  or 
closed  cavities  it  may  cause  pain,  just  as  do  ether, 
chloroform  and  other  quickly  volatilizing  liquids. 
Benzin  may  be  substituted  in  an  emergency. 

Mercuric  Cyanide  Solution.  —  The  mercuric- 
cyanide  solution  has  been  a  favorite  cleansing  so- 
lution with  me  for  many  years.  Since  I  first  called 
attention  to  its  use  in  antiseptic  surgery  (in  1898) 


158  SPRINGTIME   SURGERY 

its  use  has  become  quite  general  because  of  the 
following  advantages: 

Mercuric  cyanide  is  freely  soluble  in  hot  or  cold 
water,  and  in  alcohol ;  it  does  not  stain  the  finger- 
nails or  give  rise  to  eczema  or  other  inflamma- 
tions of  the  skin;  it  does  not  coagulate  albumen 
in  blood,  mucus,  purulent  or  other  discharges  or 
excretions;  it  is  not  precipitated  or  decomposed 
by  soap;  it  does  not  corrode  steel,  nickel  or  silver; 
it  can  be  used  in  any  kind  of  a  vessel — enameled, 
porcelain,  tin,  papier-mache  or  wooden;  it  is  in- 
expensive. 

Some  of  my  critics,  especially  the  laboratory 
bacteriologists,  have  maintained  that  mercuric 
cyanide  is  not  an  antiseptic,  that  it  will  not  in- 
hibit germ  growth ;  but  to  these  I  say  that  I  have 
used  it  for  now  more  than  ten  years,  and  the  re- 
sults have  been  more  satisfactory  than  I  obtained 
from  other  antiseptics.  The  practical  experience 
of  many  other  surgeons  corroborates  my  own. 

Other  critics  say  it  is  too  dangerous  an  anti- 
septic for  general  use,  that  its  lethal  effects  are 
too  sudden  should  one  of  the  laity  accidentally 
swallow  some  of  it.    But  these  should  remember 


TREATMENT  OF  INJURED  HAND  159 

that  this  agent  is  for  the  use  of  surgeons  and  not 
of  the  laity,  that  the  latter  have  no  business  with 
it,  and  that  in  the  hands  of  a  competent  surgeon 
it  is  as  safe  as  an  amputating  knife  or  other  in- 
strument. 

In  cleansing  the  parts  around  a  wound  it  is 
sometimes  desirable  to  use  soap,  and  I  have 
found  "mechanics*  soap,"  a  coconut-oil  soap  plus 
fine  sand,  or  rather  stone,  as  good  as  any  of  the 
higher-priced  antiseptic  soaps.  If  desirable,  an 
antiseptic  solution  may  be  used  as  a  rinsing  appli- 
cation after  the  soap. 

Hydrogen  peroxide  I  do  not  often  use  in  pri- 
mary cleansings,  since  little  difficulty  has  ever 
been  experienced  by  using  the  methods  just  de- 
scribed. Before  attempting  to  cleanse  a  wound 
always  apply  a  tourniquet  to  prevent  further 
bleeding. 

Examination  of  Injuries.  —  Having  cleansed 
the  wound  of  all  extraneous  matters,  the  surgeon 
should  see  to  it  that  his  own  hands  are  again  ren- 
dered surgically  clean,  after  which  he  may  pro- 
ceed to  examine  into  the  nature  and  extent  of  the 
injuries. 


160  SPRINGTIME  SURGERY 

In  making  such  examination,  use  the  fingers 
rather  than  instruments,  as  much  as  possible,  but 
gently,  very  gently,  depending  upon  the  tactile 
sense  to  determine  what  conditions  exist,  using 
the  eyes,  ears  and  nose  as  aids  to  the  sense  of 
touch. 

The^tactus  eruditus,  the  educated  sense  of  touch, 
is  nowhere  of  greater  importance  than  in  surgi- 
cal practice.  While  manual  dexterity  is  advan- 
tageous in  the  technic  and  mechanical  work  of  the 
profession,  the  great  importance  of  a  correct 
diagnosis  speaks  for  the  value  of  the  educated 
touch.  This  tactus  eruditus  can  be  rapidly  and 
readily  acquired  in  the  everyday  experiences  if  the 
student  or  practitioner  will  only  make  the  effort 
to  determine  size,  shape,  surface  qualities  and 
other  physical  attributes  by  the  touch,  thus  learn- 
ing to  identify  objects  by  their  "feel." 

Care  in  Handling.— Simple  superficial  wounds 
will  require  very  little  handling;  incisions,  punc- 
tures and  lacerations  due  to  known  causes  call 
for  nothing  more  than  a  careful  inspection.  Where 
the  presence  of  a  splinter  of  wood,  metal  or  glass 
is  suspected,  a  very  gentle  digital  examination 


TREATMENT  OF  INJURED  HAND  161 

body  be  a  bullet,  needle  or  other  metallic  substance, 
use  the  x-ray.  The  indiscriminate  use  of  the 
probe  in  bullet  wounds,  fractures,  necroses,  sin- 
uses, etc.,  cannot  be  too  strongly  condemned. 
Modern  methods  are  so  much  more  superior,  defi- 
nite and  less  dangerous  that  the  probe  has  been 
to  a  large  extent  rendered  obsolete  and  should 
only  be  resorted  to  when  other  methods  are  not 
at  command. 

The  tactile  sense  should  easily  detect  fractures 
and  dislocations  if  the  parts  be  not  swollen  too 
much,  and  in  open  wounds  of  joints  should  be  able 
to  determine  the  condition  of  the  cartilage  sur- 
faces. Should  it  be  necessary  to  use  instruments 
in  examining  a  wound,  they  should  be  sterilized. 

The  Sense  of  Smell. — The  sense  of  smell  is 
of  much  assistance  in  determining  the  condition 
of  wounds,  as  all  emit  characteristic  odors  of 
fresh  blood,  "healthy"  pus,  tissue  necrosis,  etc., 
according  to  their  age,  stage  of  healing,  infections 
and  dressings. 

The  odors  given  forth  by  wounds  may  be  more 
or  less  modified  by  those  natural  to  the  body,  due 
to  the  perspiration  and  other  cutaneous  secre- 


162  SPRINGTIME  SURGERY 

according  to  their  age,  stage  of  healing,  infections 
and  dressings. 

The  odors  given  forth  by  wounds  may  be  more 
or  less  modified  by  those  natural  to  the  body,  due 
to  the  perspiration  and  other  cutaneous  secre- 
tions. In  ordinary  persons  this  odor  is  sulphur- 
ous, especially  so  in  red-haired  and  freckled  indi- 
viduals; brunettes  possess  a  prussic-acid  and 
blondes  a  feeble  musk  odor;  fat  persons  have  a 
more  pronounced  odor  than  lean  ones,  the  former 
frequently  having  an  oily  odor  due  to  excessive 
fatty  acids  in  the  sebaceous  secretions.  Race,  sex, 
age,  personal  cleanliness  and  complicating  skin 
diseases  also  influence  the  odors  of  wounds. 

Various  foods  and  some  medicines  taken  inter- 
nally impart  odors  to  the  skin  secretions  which 
may  modify  the  normal  wound  odors,  and  local 
applications  to  the  seat  of  injury  may  be  expected 
to  do  so. 

A  recent  undressed  wound  presents  the  odor  of 
fresh  blood,  which,  if  there  be  union  by  first  in- 
tention, gives  way  to  that  of  the  dressings  ap- 
plied. A  wound  bathed  in  pus  from  healthy  gran- 
ulations gives  a  characteristic  odor  which  is  not 


TREATMENT  OP  INJURED  HAND  168 

offensive;  if,  however,  there  be  necrosis,  decom- 
position of  the  discharges  or  maceration  of  callo- 
sities or  scabs,  there  is  a  very  pronounced  and  dis- 
agreeable odor  of  putrefaction.  I  have  noticed  in 
wounds  in  syphilitics  a  characteristic  odor,  also  in 
those  made  by  ice-cutting  tools,  and  in  human 
bites.  Wounds  infected  with  glanders  or  diph- 
theria present  the  peculiar  odors  of  those  diseases. 
All  these  things  the  experienced  surgeon  bearg  in 
mind. 

Macroscopic  inspection  of  wounds  will  reveal 
much  concerning  their  extent  and  condition,  but 
the  eye  must  be  supported  by  the  touch,  as  there 
are  many  things  in  an  injury  which  the  eye  cannot 
detect  and  many  appearances  which  are  highly  de- 
ceptive. In  cases  where  there  is  doubt  as  to  the 
nature  of  infection  resort  is  had  to  bacteriologic 
culture  and  miscroscopic  examinations. 

A  most  important  adjunct  to  the  ocular  exami- 
nation of  injuries  is  the  x-ray  apparatus  whereby 
fractures,  dislocations,  bone  inflammations  and 
necrosis  can  be  definitely  determined  and  metallic 
bodies  located. 


Webster  Family  Library  of  Veterinary  IVIedicine  ' 
Ciimminss  School  of  Veterinary  Medicine  at 

Tufts  University 

200  Westboro  Road         .^f^ 

North  Grafton.  MA  01536  ^    ..^^.-i.^M 


